SUMMARY REPORT ON TRANSITIONAL REINSURANCE … · 6/30/2015 · PAYMENTS AND PERMANENT RISK ADJUSTMENT TRANSFERS . FOR THE 2014 BENEFIT YEAR . Issued: June 30, 2015 . RI-RA Payments

DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight 200 Independence Avenue SW Washington, DC 20201

SUMMARY REPORT ON

TRANSITIONAL REINSURANCE PAYMENTS AND PERMANENT RISK

ADJUSTMENT TRANSFERS FOR THE 2014 BENEFIT YEAR

Issued: June 30, 2015

RI-RA Payments Report Page 1 _______________________________________________________________________________________________

I. Highlights of the Summary Report on Transitional Reinsurance Payments and

Permanent Risk Adjustment Transfers for the 2014 Benefit Year

• 99.7 percent of issuers who set up EDGE servers successfully submitted the data necessary to calculate reinsurance payments and risk adjustment transfers.

• Transitional Reinsurance Program • Our preliminary analysis of the transitional reinsurance program for the 2014 benefit

year shows that the reinsurance program is working as intended – by providing protection to issuers with exceptionally high costs.

• As announced on June 17, 2015, for the 2014 benefit year, reinsurance contributions exceeded the requests for reinsurance payments; therefore we have increased the coinsurance rate to 100 percent.1

• For the 2014 benefit year, over $7.9 billion in reinsurance payments will be made to 437 issuers nationwide.

• Permanent HHS Risk Adjustment Program • Our preliminary analysis of the risk adjustment transfers for the 2014 benefit year shows

that the risk adjustment methodology is working as intended – by compensating issuers that enrolled higher risk individuals and protecting against adverse selection within a market within a state. For example, we have found that: • Issuers that enrolled a large share of HIV/AIDS patients, whether because they offered

more robust prescription drug coverage or contracted with the Ryan White Foundation, received risk adjustment payments;

• Issuers that attracted more high-risk patients due to networks that include key specialty hospitals received risk adjustment payments;

• Issuers that had a history of serving high risk individuals as the issuer of last resort and therefore enrolled a disproportionate number of expensive consumers received risk adjustment payments; and

• Small plans with isolated cases of catastrophically ill individuals received risk adjustment payments.

II. Background The Affordable Care Act establishes a transitional reinsurance program (in section 1341) and a permanent risk adjustment program (in section 1343), two of three premium stabilization programs, to provide payments to health insurance issuers that cover higher-cost and higher-risk populations to more evenly spread the financial risk borne by issuers and help stabilize premiums. Beginning with plan years that begin in 2014, the Affordable Care Act provides that non-grandfathered plans in the individual and small group markets can no longer discriminate against enrollees due to their health status. Individuals with pre-existing conditions or chronic illnesses generally can no longer be charged higher premiums by plans in these markets based on their health status.

1Available at: http://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/Downloads/RI-Payments-National-Proration-Memo-With-Numbers-6-17-15.pdf.

http://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/Downloads/RI-Payments-National-Proration-Memo-With-Numbers-6-17-15.pdf

http://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/Downloads/RI-Payments-National-Proration-Memo-With-Numbers-6-17-15.pdf


The reinsurance program, which started in the 2014 benefit year, is designed to provide issuers with greater payment stability, both for the Marketplace and outside of the Marketplace, as the insurance market reforms are implemented and the Marketplaces facilitate increased enrollment. The reinsurance program will help reduce the uncertainty of insurance risk in the individual market by partially offsetting issuers’ claims associated with high-cost enrollees. The risk adjustment program provides payments to health insurance issuers that attract high-risk enrollees, such as those with chronic conditions, reduces the incentives for issuers to avoid those enrollees, and lessens the potential influence of risk selection on the premiums that plans charge. The program therefore incentivizes issuers to provide coverage with an appropriate level of benefits and services at an affordable premium.

As described in the HHS Notice of Benefit and Payment Parameters for 2014 Final Rule (78 FR 15410), the risk adjustment methodology developed by the Department of Health and Human Services (HHS) is based on the premise that premiums should reflect the differences in plan benefits, quality, and efficiency – not the health status of the enrolled population. The HHS-developed risk adjustment methodology determines each plan’s risk adjustment transfer amount based on the actuarial risk of enrollees, the actuarial value of coverage, utilization and the cost of doing business in local rating areas, and the effect of different cost-sharing levels on utilization. This methodology, which HHS applied in 49 states and the District of Columbia,2 transfers funds from plans with low risk enrollees to plans with high risk enrollees.

Pursuant to 45 CFR 153.240(b)(1)(ii), today, HHS is making a report available to each issuer of a reinsurance-eligible plan that will include the issuer’s total estimated reinsurance payment for the 2014 benefit year, calculated based on the reinsurance contributions HHS has already collected and the contributions that are scheduled to be collected by November 15, 2015, and reflecting the 2014 coinsurance rate of 100 percent. Pursuant to 45 CFR 153.310(e), HHS is also making a report available to each issuer of a risk adjustment covered plan that will include the issuer’s risk adjustment payment or charge.3 In addition to the reports for issuers described above, HHS is publishing this report making publicly available certain summary data and issuer-specific data on the reinsurance and HHS risk adjustment programs for the 2014 benefit year. We note that the risk adjustment transfer amounts and reinsurance payment amounts below do not reflect any payment or charge adjustments due to discrepancies or appeals or effects of sequestration.4 Additionally, data included in this report reflect amounts calculated based on the reinsurance payment parameters and risk adjustment methodology outlined in regulation (78 FR 15410 and 45 CFR Part

2 Massachusetts operates its own risk adjustment program. 3 HHS will notify issuers through an announcement from https://www.regtap.info/ when the reports will be available for download through the EDGE server management console. 4 As stated in the Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond; Final Rule (79 FR 30257), the risk adjustment and reinsurance programs will be sequestered in fiscal year 2015. However, HHS, in coordination with the OMB, has determined that, pursuant to section 256(k)(6) of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, and the underlying authority for these programs, funds that are sequestered in fiscal year 2015 from the reinsurance and risk adjustment programs will become available for payment to issuers in fiscal year 2016 without further congressional action.

https://www.regtap.info/


153) and is provided for informational purposes. These amounts do not constitute specific obligations of federal funds to any particular issuer or plan.

III. Transitional Reinsurance Program Summary Data

Table 1: Reinsurance Summary Data

SUMMARY DATA ELEMENT TOTALS

Number of Issuers with Enrollment in Reinsurance-Eligible Individual Market Plans,

Nationwide

484

Number of Issuers Receiving Reinsurance Payments, Nationwide5

437

Dollar Value of 2014 Benefit Year Reinsurance Payment Requests

Approximately $7.9 billion

Total 2014 Benefit Year Reinsurance Contributions Collected to Date

Approximately $8.7 billion

Estimated 2014 Benefit Year Reinsurance Contributions to be Collected by or before November 15, 2015 for Use in Subsequent

Years

Approximately $1 billion

Uniform Payment Parameters for 2014

$45,000 attachment point, $250,000 reinsurance cap and 100 percent coinsurance

rate

Note: In the Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond; Final Rule (79 FR 30240), we state that if reinsurance contribution collections do not meet our projections, any contributions up to $10 billion would be allocated to reinsurance payments for the 2014 benefit year. Therefore, any reinsurance contributions from 2014 not used to make payments this year will be used to make reinsurance payments for the next year.

5 Reinsurance-eligible issuers with enrollee(s) whose paid claims exceeded the $45,000 attachment point threshold for reinsurance payments for the 2014 benefit year. This total also includes issuers in Connecticut receiving reinsurance payments.


IV. HHS Risk Adjustment Program Summary Data6

Table 2: HHS Risk Adjustment Program Summary Data7

HHS RISK ADJUSTMENT TRANSFER CATEGORY

NUMBER OF ISSUERS WITH RISK

ADJUSTMENT COVERED PLANS IN

HHS RISK ADJUSTMENT8

Total Number of Issuers Participating in HHS Risk Adjustment Transfers 758

Number of Issuers with Individual Non-Catastrophic Plans 468

Number of Issuers with Individual Catastrophic Plans 291

Number of Issuers with Small Group Plans 628 Number of Issuers in a Merged Market

(Individual and Small Group) 2

Table 3: National Average Enrollment Weighted Monthly Premium by Risk Pool9

RISK POOL NATIONAL AVERAGE

ENROLLMENT WEIGHTED MONTHLY PREMIUM

Individual $356.62 Small Group $441.48 Catastrophic $155.20

Merged $439.17 National Average Premium $380.87

6 All data summarized in this report was calculated using 2014 EDGE Data. For the 2014 benefit, Massachusetts was the only state electing to operate a risk adjustment program. Data displayed for risk adjustment does not include Massachusetts. 7 The total of the three market risk pool groups on this table will not sum to the total issuers with risk adjustment transfer calculations because some issuers provided plans in multiple markets. 8 Plan counts for issuers with a default charge calculation are not included in counts for the market in which they are being assessed this charge. It also does not include issuers that participated in Massachusetts’s risk adjustment program. 9 Data includes only those issuers that successfully submitted data to the EDGE server as part of the HHS risk adjustment program. Premiums represent the average per member per month amount. They do not include any reduction in premiums due to Advanced Premium Tax Credits.


Table 4: HHS Risk Adjustment Absolute Value of Transfer Amounts as a Percent of Premium

by Risk Pool

Table 4 illustrates the total percent of dollars that is expected to be transferred within each market by using the absolute value of net transfers for each issuer operating within the market risk pool. The percentages are calculated based on summation of the absolute value of net transfers for each issuer in a specific market risk pool. This means that for net charges (otherwise reported as negative) we included the absolute value in the equation, net payments are already positive. This amount is then divided by the total premium for the market risk pool, which is calculated as the sum of the products of plan average premium and the billable member months.

RISK POOL ABSOLUTE VALUE OF

TRANSFER AMOUNTS AS A PERCENT OF PREMIUM10

Individual 10 percent Small Group 6 percent Catastrophic 21 percent

Merged 2 percent

10Absolute value of net transfer charge or payment calculated at issuer level.


V. HHS Risk Adjustment Program State-Specific Data

*For the 2014 benefit, Massachusetts was the only state electing to operate a risk adjustment program. Therefore, Massachusetts is not reflected in Table 5 below. See Appendix A for a description of the calculations for State Average Premium, State Average Plan Liability Risk Score, State Average Allowable Rating Factor, and State Average Actuarial Value.

Table 5: Risk Adjustment State Averages

STATE RISK POOL

STATE AVERAGE MONTHLY PREMIUMS

STATE AVERAGE

PLAN LIABILITY

RISK SCORE

STATE AVERAGE

ALLOWABLE RATING FACTOR

STATE AVERAGE

ACTUARIAL VALUE

AK Catastrophic $225.62 0.359 1.033 0.570

Individual $503.08 1.563 1.616 0.678 Small Group $618.70 1.107 1.429 0.711

AL Catastrophic $161.62 0.573 1.162 0.570


AR Catastrophic $139.73 0.178 1.022 0.570


AZ Catastrophic $133.40 0.403 1.046 0.570


CA Catastrophic $169.11 0.269 0.973 0.570


CO Catastrophic $164.55 0.302 1.041 0.570


CT Catastrophic $267.58 0.559 1.253 0.570


DC Catastrophic $75.09 0.132 0.734 0.570



STATE RISK POOL


STATE AVERAGE

PLAN LIABILITY

RISK SCORE

STATE AVERAGE


STATE AVERAGE

ACTUARIAL VALUE

DE Catastrophic $147.29 0.302 1.018 0.570


FL Catastrophic $149.07 0.388 1.148 0.570


GA Catastrophic $154.87 0.447 1.138 0.570


HI Catastrophic $134.83 0.570 1.001 0.570


IA Catastrophic $106.49 0.185 0.994 0.570


ID Catastrophic $124.50 0.253 0.930 0.570


IL Catastrophic $163.17 0.397 1.071 0.570


IN Catastrophic $223.49 0.580 1.217 0.570


KS Catastrophic $107.56 0.381 0.999 0.570


KY Catastrophic $144.14 0.508 1.109 0.570



STATE RISK POOL


STATE AVERAGE

PLAN LIABILITY

RISK SCORE

STATE AVERAGE


STATE AVERAGE

ACTUARIAL VALUE

LA Catastrophic $159.73 0.370 1.106 0.570


MD Catastrophic $97.87 0.233 0.988 0.570


ME Catastrophic $183.03 0.275 1.071 0.570


MI Catastrophic $131.74 0.350 1.026 0.570


MN Catastrophic $92.09 0.254 1.011 0.570


MO Catastrophic $120.21 0.343 0.997 0.570


MS Catastrophic $194.13 0.507 1.151 0.570


MT Catastrophic $161.79 0.242 1.021 0.570


NC Catastrophic $129.01 0.360 0.958 0.570


ND Catastrophic $162.88 0.190 1.052 0.570



STATE RISK POOL


STATE AVERAGE

PLAN LIABILITY

RISK SCORE

STATE AVERAGE


STATE AVERAGE

ACTUARIAL VALUE

NE Catastrophic $138.51 0.215 1.020 0.570


NH Catastrophic $192.07 0.297 1.120 0.570


NJ Catastrophic $192.48 0.318 1.226 0.570


NM Catastrophic $108.97 0.175 0.943 0.570


NV Catastrophic $185.53 0.518 1.103 0.570


NY Catastrophic $189.40 0.173 0.999 0.570


OH Catastrophic $153.42 0.397 1.061 0.570


OK Catastrophic $134.18 0.337 1.023 0.570


OR Catastrophic $112.38 0.181 1.024 0.570


PA Catastrophic $143.84 0.367 1.095 0.570



STATE RISK POOL


STATE AVERAGE

PLAN LIABILITY

RISK SCORE

STATE AVERAGE


STATE AVERAGE

ACTUARIAL VALUE

RI Catastrophic $167.38 0.324 1.124 0.570


SC Catastrophic $140.68 0.224 0.967 0.570


SD Catastrophic $159.75 0.455 0.963 0.570


TN Catastrophic $144.56 0.559 1.172 0.570


TX Catastrophic $155.57 0.568 1.095 0.570


UT Catastrophic $119.05 0.388 1.261 0.570


VA Catastrophic $142.53 0.316 1.072 0.570


VT Catastrophic $204.45 0.246 0.999 0.570

Merged $439.17 1.462 0.981 0.739

WA Catastrophic $181.55 0.162 1.032 0.570


WV Catastrophic $197.17 0.441 1.164 0.570


WI Catastrophic $170.98 0.305 1.045 0.570


STATE RISK POOL


STATE AVERAGE

PLAN LIABILITY

RISK SCORE

STATE AVERAGE


STATE AVERAGE

ACTUARIAL VALUE


WY Catastrophic $204.86 0.165 0.987 0.570


VI. Risk Adjustment and Reinsurance Program Issuer-Specific Data

Below we set forth the 2014 reinsurance payment amounts and the HHS risk adjustment transfer amounts by issuer. *Not Eligible: Some of these issuers are not eligible for reinsurance payments because they have no 2014 enrollment in individual market health insurance plans or because they have no enrollment in reinsurance-eligible plans. A reinsurance-eligible plan is defined under 45 CFR 153.20, as any health insurance coverage offered in the individual market, except for grandfathered plans and health insurance coverage not required to submit reinsurance contributions. Similarly, some of these issuers have no 2014 enrollment in risk adjustment covered plans in one of the listed market segments. A risk adjustment covered plan is defined under 45 CFR 153.20, as any health insurance coverage offered in the individual or small group market with the exception of grandfathered health plans, group health insurance coverage described in 45 CFR 146.145(c), individual health insurance coverage described in 45 CFR 148.220, and any plan determined not to be a risk adjustment covered plan in the applicable federally certified risk adjustment methodology.

**For the 2014 benefit year, Connecticut was the only state electing to operate a reinsurance program. The issuers in this state are leveraging the EDGE server data submission process; therefore, to provide a comprehensive view of the transitional reinsurance program, we have included the reinsurance payment amount for Connecticut by issuer in Table 6 below.

***For the 2014 benefit year, Massachusetts was the only state electing to operate a risk adjustment program. Therefore, in Table 6 below, we do not list any Massachusetts issuers’ risk adjustment transfer amounts. These issuers’ risk adjustment transfer amounts will be listed as “N/A – MA Issuer.”


Table 6: Issuer-Specific Information11

11 We note the risk adjustment transfer amounts and reinsurance payment amounts below do not reflect any payment or charge adjustments due to discrepancies or appeals or effects of sequestration. Due to rounding in the risk adjustment transfer formula the transfer equation does not always balance to the cent.

HIOS ID

HIOS INPUTTED INSURANCE COMPANY

NAME STATE

REINSURANCE PAYMENT

AMOUNT (OR NOT ELIGIBLE)

HHS RISK ADJUSTMENT

TRANSFER AMOUNT

(INDIVIDUAL MARKET,

INCLUDING CATASTROPHIC)

HHS RISK ADJUSTMENT TRANSFERS

AMOUNT (SMALL GROUP

MARKET)

11082 Aetna Life Insurance Company AK $120,363.61 $(52,362.57) $22,831.39

62637 John Alden Life Insurance Company AK Not Eligible $ - $78,962.62

73836 Moda Health Plan, Inc. AK $13,102,419.34 $(4,806,964.11) $24,371.00

38344 Premera Blue Cross Blue Shield of Alaska AK $19,984,669.96 $5,782,175.12 $(119,931.53)

38596 Time Insurance Company AK $1,558,728.91 $ (922,848.49) $(317,715.76)

80049 UnitedHealthcare Insurance Company AK Not Eligible $ - $311,482.27

42159 All Savers Insurance Company AL Not Eligible $ - $(2,634.74)

46944 Blue Cross and Blue Shield of Alabama AL $97,314,734.65 $993,113.39 $1,551,403.36

44902 Federated Mutual Insurance Company AL Not Eligible $ - $(7,318.77)

93122 Freedom Life Insurance AL $107,806.57 $26,222.47 $ -

44580 Humana Insurance Company AL $3,619,049.98 $(983,926.61) $ -

49771 John Alden Life Insurance Company AL Not Eligible $ - $9,879.88

13939 Time Insurance Company AL $661,562.99 $(35,409.21) $11,262.04

69461 UnitedHealthcare Insurance Company AL Not Eligible $ - $206,168.06

59809 UnitedHealthcare Life Insurance Company AL Not Eligible $ - $4,588.49

68259 UnitedHealthcare of Alabama, Inc. AL Not Eligible $ - $(59,273.72)

93018 VIVA Health AL Not Eligible $ - $(1,714,074.57)

62141 Celtic Insurance Company AR $6,888,210.15 $(8,621,410.48) $ -


60079 Coventry Health and Life AR $0.00 $(4,414.54) $(44,702.70)

89365 Federated Mutual Insurance Company AR Not Eligible $ - $(55,065.97)

61273 Freedom Life Insurance AR $0.00 $(3,621.42) $ -

13262 HMO Partners, Inc. AR Not Eligible $ - $210,345.00

99685 Humana Insurance Company AR $29,192.62 $68,170.50 $27,385.89

51826 John Alden Life Insurance Company AR Not Eligible $ - $(15,335.35)

70525 QCA Health Plan, Inc. AR $4,262,438.76 $(5,943,287.09) $(55,681.10)

37903 QualChoice Life & Health Insurance Company, Inc. AR Not Eligible $ - $(83,211.31)

30991 Time Insurance Company AR $2,304,205.03 $(2,043.49) $(50,048.48)

22732 UnitedHealthcare Ins Co of River Valley AR Not Eligible $ - $(590,630.26)

81392 UnitedHealthcare Insurance Company AR Not Eligible $ - $387,592.55

53135 UnitedHealthcare Life Insurance Company AR $256,733.54 $71,131.67 $ -

65817 UnitedHealthcare of Arkansas, Inc. AR Not Eligible $ - $(112,065.94)

75293 USAble Mutual Insurance Company AR $64,727,145.97 $14,435,474.74 $381,417.67

78611 Aetna Health Inc. (a PA corp.) AZ Not Eligible $- $324,131.01

84251 Aetna Life Insurance Company AZ $3,503,089.05 $(437,141.10) $(3,375,392.32)

98971 All Savers Insurance Company AZ Not Eligible $ - $(8,390.44)

53901 Blue Cross Blue Shield of Arizona, Inc. AZ $43,213,850.11 $14,331,092.97 $1,494,667.03

86830 Cigna Health and Life Insurance Company AZ $4,060,861.27 $1,978,320.29 $(24,005.57)

75849 Freedom Life Insurance AZ $68,741.80 $1,902.67 $ -

70239 Health Choice Insurance Co. AZ $678,956.76 $(243,631.04) $ -

51485 Health Net Life Insurance Company AZ $39,878,281.54 $469.35 $335,791.07

91450 Health Net of Arizona, Inc. AZ $26,048,764.45 $(26,088,803.10) $(2,284,176.05)

23307 Humana Health Plan, Inc. AZ $4,828,508.31 $(351,373.90) $(750,038.97)

66105 Humana Insurance Company AZ $1,448,006.99 $1,164,384.91 $27,209.69


73893 John Alden Life Insurance Company AZ Not Eligible $ - $700,477.89

23029 Madison National Life AZ Not Eligible $ - $(4,301.51)

60761 Meritus Health Partners AZ $1,971,188.38 $2,073,821.34 $(29,408.53)

92045 Meritus Mutual Health Partners AZ $1,966,944.08 $800,921.39 $(12,159.89)

59096 Standard Security Life AZ Not Eligible $ - $(615.14)

80863 Time Insurance Company AZ $13,874,351.63 $5,883,719.72 $784,218.43

82011 UnitedHealthcare Insurance Company AZ Not Eligible $ - $2,961,325.69

90169 UnitedHealthcare Life Insurance Company AZ $1,610.82 $28,226.14 $ -

40702 UnitedHealthcare of Arizona, Inc. AZ Not Eligible $ - $(139,332.36)

88925 University of Arizona Health Plans-University Healthcare,

Inc. AZ $292,653.92 $858,090.36 $ -

20523 Aetna Health of California Inc. CA Not Eligible $ - $(23,489,767.02)

40733 Aetna Life Insurance Company CA Not Eligible $ - $(1,519,853.96)

27603 Blue Cross of California(Anthem BC) CA $401,126,393.31 $(181,692,588.01) $23,364,909.92

70285 CA Physician's Service dba Blue Shield of CA CA $363,050,264.53 $135,212,707.60 $13,755,875.29

47579 Chinese Community Health Plan CA $1,824,095.22 $(16,711,278.79) $ (3,067,299.35)

40025 Cigna Health and Life Insurance Company CA $21,440,171.45 $17,743,436.54 $ -

99483 CONTRA COSTA HEALTH PLAN CA $2,293,366.91 $1,753,287.86 $ -

84014 County of Santa Clara CA $440,556.13 $(318,460.38) $ -

56887 County of Ventura, dba

Ventura County Health Care Plan

CA Not Eligible $ - $500,462.21

99110 Health Net Life Insurance Company CA $96,305,759.81 $53,801,059.26 $(1,149,328.11)

67138 Health Net of California, Inc. CA $48,731,305.15 $(100,186,993.89) $(3,718,209.96)

68744 Humana Insurance Company CA Not Eligible $ - $8,197.35

40513 Kaiser Foundation Health Plan, Inc. CA $240,031,290.84 $98,811,448.39 $(6,119,361.66)

27330 Kaiser Permanente Insurance Company CA Not Eligible $ - $(178,446.96)


92815 Local Initiative Health

Authority for Los Angeles County

CA $347,123.67 $(31,742,828.09) $ -

18126 MOLINA HEALTHCARE OF CALIFORNIA CA $950,343.48 $(9,072,047.23) $ -

92499 Sharp Health Plan CA $10,986,209.85 $10,432,568.53 $(953,791.37)

64198 Time Insurance Company CA $45,901,082.37 $19,393,416.27 $ -

35305 Trustmark Life Insurance Company CA Not Eligible $ - $(132,284.52)

49116 UHC of California CA Not Eligible $ - $(2,215,283.01)

95677 UnitedHealthcare Insurance Company CA Not Eligible $ - $4,029,609.65

93689 Western Health Advantage CA $5,847,162.74 $2,576,272.04 $884,571.67

92137 All Savers Insurance Company CO $547,719.39 $481,970.65 $ -

49375 Cigna Health and Life Insurance Company CO $10,847,936.42 $10,208,969.51 $ -

63312 Colorado Choice Health Plans CO $6,252,605.70 $(4,578,461.04) $(534,596.16)

20472 Colorado Health Insurance Cooperative, Inc. CO $19,571,825.50 $(4,393,875.95) $(97,502.97)

66699 Denver Health Medical Plan, Inc. CO $426,657.77 $2,412,384.60 $ -

76680 HMO Colorado, Inc., dba HMO Nevada CO $12,493,994.43 $261,875.80 $(860,371.91)

74320 Humana Health Plan CO $9,089,477.33 $4,731,745.94 $(2,841,602.51)

79509 Humana Insurance Company CO $1,310,478.81 $1,264,744.68 $139,778.65

21032 Kaiser Foundation Health Plan of Colo. CO $26,956,984.91 $(33,664,830.89) $(3,582,183.17)

35944 KAISER PERMANENTE INSURANCE COMPANY CO Not Eligible $ - $(49,499.07)

11555 New Health Ventures Inc. CO $205,000.00 $99,152.72 $ -

80208 Rocky Mountain Health Care Options CO Not Eligible $ - $404,793.25

97879 Rocky Mountain HMO CO $54,104,079.51 $13,887,675.22 $(16,089.07)

87269

Rocky Mountain Hospital and Medical Service, Inc.,

dba Anthem Blue Cross and Blue Shield

CO Not Eligible $ - $2,272,512.47

39060 Time Insurance Company CO $16,138,881.92 $9,288,648.71 $ -


67879 UnitedHealthcare Insurance Company CO Not Eligible $ - $3,694,826.77

59036 UnitedHealthcare of Colorado, Inc. CO Not Eligible $ - $1,469,933.76

39159 Aetna Life Insurance Company CT $5,454,083.60 $2,822,391.74 $2,719,970.89

86545 Anthem Health Plans Inc. (Anthem BCBS) CT $53,879,332.07 $13,893,512.78 $1,456,630.51

74684 Celtic Insurance Company** CT $0.00 $(376.51) $ -

87354 Cigna Health and Life Insurance Company** CT $1,443,523.59 $(45,977.45) $ -

76962 ConnectiCare Benefits, Inc. ** CT $22,088,564.32 $(6,289,036.98) $ -

94815 ConnectiCare Insurance Company, Inc. ** CT $13,127,918.24 $(10,948,959.34) $(7,957,364.87)

75091 ConnectiCare, Inc. ** CT $9,490.20 $(115,248.13) $72,069.21

95882 Harvard Pilgrim Health Care of Connecticut, Inc. ** CT Not Eligible $ - $9,449.37

91069 HealthyCT, Inc. ** CT $1,944,236.31 $(569,431.67) $(532,743.60)

89130 HPHC Insurance Company, Inc. ** CT Not Eligible $ - $(130,325.86)

29462 Oxford Health Insurance, Inc. ** CT Not Eligible $ - $4,715,438.40

71179 Oxford Health Plans (CT), Inc. ** CT Not Eligible $ - $(86,030.15)

86542 Time Insurance Company** CT $2,907,270.19 $1,253,125.49 $ -

49650 UnitedHealthcare Insurance Company CT Not Eligible $ - $(267,093.84)

73987 Aetna Health Inc. (a PA corp.) DC Not Eligible $ - $(239,619.32)

77422 Aetna Life Insurance Company DC $0.00 $(45,424.71) $400,712.47

86052 CareFirst BlueChoice, Inc. DC $1,900,356.26 $(1,007,058.65) $(6,732,251.48)

78079 GHMSI DC $2,071,230.11 $1,803,989.23 $8,238,082.97

94506 Kaiser Foundation Health Plan of the Mid-Atlantic

States, Inc. DC $316,474.04 $(751,505.85) $(1,598,160.33)

75753 Optimum Choice, Inc. DC Not Eligible $ - $186,718.46

41842 UnitedHealthcare Insurance Company DC Not Eligible $ - $(255,482.82)

67190 Aetna Health Inc. (a PA corp.) DE Not Eligible $ - $12,382.86


29497 Aetna Life Insurance Company DE $290,104.21 $(357,373.55) $(77,166.51)

13537 Coventry Health and Life DE $437,178.28 $3,410.60 $ -

81914 Coventry Health Care of Delaware, Inc. DE $628,973.12 $(427,183.66) $235,718.45

76168 Highmark BCBSD Inc. DE $17,745,845.52 $727,926.00 $(438,027.53)

78960 John Alden Life Insurance Company DE Not Eligible $ - $(2,542.01)

97569 Optimum Choice, Inc. DE Not Eligible $ - $(45,756.59)

97889 Time Insurance Company DE $512,544.50 $53,220.61 $(4,709.65)

61021 UnitedHealthcare Insurance Company DE Not Eligible $ - $320,100.97

18628 Aetna Health Inc. (a FL corp.) FL $1,205,126.79 $(525,058.02) $389,940.41

23841 Aetna Life Insurance Company FL $32,190,446.23 $20,415,906.73 $1,330,151.83

42204 All Savers Insurance Company FL Not Eligible $ - $31,520.79

19898 AvMed, Inc. FL $1,841,557.61 $1,215,541.75 $(3,118,661.50)

16842 Blue Cross and Blue Shield of Florida FL $265,367,761.31 $221,628,751.90 $4,537,166.63

66966 Capital Health Plan FL Not Eligible $ - $635,267.48

21663 Celtic Insurance Company FL $14,820.41 $143,355.70 $ -

48121 Cigna Health and Life Insurance Company FL $75,559,934.98 $39,512,510.93 $ -

76089 Coventry Health and Life Insurance Co. FL Not Eligible $ - $107,518.39

57451 Coventry Health Care of Florida, Inc. FL $63,556,095.78 $(160,958,367.07) $90,797.90

92120 Coventry Health Plan of Florida, Inc. FL $1,838,893.01 $824,165.75 $ -

56503 Florida Health Care Plan, Inc. FL $3,957,217.77 $4,718,787.44 $(69,476.10)

40442 Freedom Life Insurance FL $197,590.16 $34,088.70 $ -

27357 Health First Health Plans, Inc. FL Not Eligible $ - $(761,118.31)

77150 Health First Insurance, Inc. FL $1,503,848.43 $(723,613.84) $(391,901.29)

30252 Health Options, Inc. FL $61,800,974.07 $32,115,302.73 $(1,315,788.63)

99308 Humana Health Insurance Co of FL, Inc. FL $548,088.02 $185,940.22 $(116,650.43)


15980 Humana Insurance Company FL $525,367.39 $483,961.79 $ -

35783 Humana Medical Plan, Inc. FL $125,344,110.04 $(80,860,989.32) $(6,552,473.44)

41240 John Alden Life Insurance Company FL Not Eligible $ - $(890.28)

54172 Molina Healthcare of Florida, Inc. FL $413,077.75 $664,162.18 $ -

80779 Neighborhood Health Partnership, Inc. FL Not Eligible $ - $(171,191.73)

51398 Preferred Medical Plan, Inc. FL $19,151,683.89 $(97,122,695.74) $ -

86382 Sunshine State Health Plan FL $0.00 $(198,355.63) $ -

62662 Time Insurance Company FL $24,416,837.37 $11,930,582.36 $(119,621.80)

43839 UnitedHealthcare Insurance Company FL Not Eligible $ - $3,844,812.86

17341 UnitedHealthcare Life Insurance Company FL $7,942,642.06 $6,516,021.26 $ -

68398 UnitedHealthcare of Florida, Inc. FL Not Eligible $ - $1,650,597.60

82824 Aetna Health Inc. (a GA corp.) GA Not Eligible $ - $(1,390,717.91)

83978 Aetna Life Insurance Company GA $2,623,982.14 $(500,123.69) $(3,143,639.65)

83761 Alliant Health Plans GA $7,265,449.74 $2,745,962.25 $(1,464,662.42)

82894 Athens Area Health Plan Select, Inc. GA Not Eligible $ - $(637,297.59)

63411 Blue Cross and Blue Shield of Georgia, Inc. GA Not Eligible $ - $1,729,140.20

49046 Blue Cross Blue Shield

Healthcare Plan of Georgia, Inc.

GA $34,663,581.85 $(3,958,982.30) $2,304,375.99

24775 Celtic Insurance Company GA $0.00 $7,411.32 $ -

50491 Cigna Health and Life Insurance Company GA $3,655,883.02 $3,395,529.35 $ -

65890 Coventry Health and Life GA Not Eligible $ - $(4,418.49)

47783 Coventry Health Care of Georgia, Inc. GA $3,255,942.16 $(3,608,858.91) $2,304,241.03

38835 Federated Mutual Insurance Company GA Not Eligible $ - $(55,911.28)

72796 Freedom Life Insurance GA $0.00 $(212.84) $ -

93332 Humana Employers Health Plan of Georgia, Inc. GA $203,653,702.40 $64,808.72 $(6,158.42)


37001 Humana Insurance Company GA $2,091,544.94 $2,184,957.04 $721,767.42

50313 John Alden Life Insurance Company GA Not Eligible $ - $159,888.81

89942 Kaiser Foundation Health Plan of Georgia GA $7,879,843.09 $(745,460.89) $(2,820,212.21)

82302 Kaiser Permanente Insurance Company GA Not Eligible $ - $(14,361.39)

12442 Nippon Life Insurance Company of America GA Not Eligible $ - $(113,027.35)

45495 Peach State Health Plan GA $752,278.28 $(3,689,629.38) $ -

20544 Time Insurance Company GA $8,301,134.79 $4,104,599.26 $462,396.82

30552 UnitedHealthcare Ins Co of River Valley GA Not Eligible $ - $(510,878.36)

13535 UnitedHealthcare Insurance Company GA Not Eligible $ - $2,602,799.56

43802 UnitedHealthcare of Georgia, Inc. GA Not Eligible $ - $(123,324.74)

14479 Family Health Hawaii mbs HI Not Eligible $ - $(541,621.36)

56682 Hawaii Medical Assurance Association HI Not Eligible $ - $(213,033.45)

18350 Hawaii Medical Service Association HI $13,001,803.35 $10,430,372.28 $5,740,424.58

60612 Kaiser Foundation Health Plan, Inc. HI $4,687,278.77 $(10,430,372.26) $(4,366,914.44)

54179 UnitedHealthcare Insurance Company HI Not Eligible $ - $1,398.35

95366 University Health Alliance (UHA) HI Not Eligible $ - $(620,253.71)

74980 Avera Health Plans, Inc. IA $37,384.36 $(46,538.07) $(8,630.65)

87194 Celtic Insurance Company IA $0.00 $(1,222.36) $ -

71268 CoOportunity Health IA $24,918,368.43 $7,585,020.87 $(3,442,183.75)

51820 Coventry Health and Life Insurance Co. IA Not Eligible $ - $(19,282.26)

18973 Coventry Health Care of Iowa Inc. IA $13,395,052.40 $(9,236,606.28) $(142,786.86)

41397 Federated Mutual Insurance Company IA Not Eligible $ - $(24,092.66)

27651 Gundersen Health Plan, Inc. IA $97,464.02 $(19,844.29) $(46,725.06)

77638 Health Alliance Midwest, Inc. IA Not Eligible $ - $(19,846.16)

67580 John Alden Life Insurance Company IA Not Eligible $ - $(63,213.98)


50735 Medical Associates Health Plans IA Not Eligible $ - $(285,469.43)

51474 Pekin Life Insurance Company IA Not Eligible $ - $(61,839.36)

85930 Sanford Health Plan IA Not Eligible $ - $36,341.21

48569 Standard Security Life IA Not Eligible $ - $(2,102.24)

68184 Time Insurance Company IA $1,242,068.11 $(338,678.10) $(13,859.22)

88678 UnitedHealthcare Insurance Company IA Not Eligible $ - $111,696.10

56610 UnitedHealthcare Plan of the River Valley, Inc. IA Not Eligible $ - $(54,442.57)

25896 Wellmark Health Plan of Iowa IA $782,563.16 $(2,547,979.51) $501,033.39

72160 Wellmark Inc. IA $13,566,797.89 $4,605,847.67 $3,535,403.52

61175 Aetna Health of Utah Inc. ID $18,151.34 $(24,771.68) $(157,276.56)

61589 Blue Cross of Idaho Health Service, Inc. ID $46,067,383.55 $(7,228,265.36) $557,788.36

59765 BridgeSpan Health Company ID $712,878.62 $574,321.44 $ -

52156 John Alden Life Insurance Company ID Not Eligible $ - $45,076.99

60597 PacificSource Health Plans ID $2,266,284.66 $663,249.20 $(228,325.54)

44648 Regence Blue Shield of Idaho ID $282,450.45 $371,605.98 $1,175,263.46

26002 SelectHealth ID $22,446,618.57 $5,450,923.74 $(1,392,526.68)

28218 Time Insurance Company ID $510,134.56 $192,936.56 $ -

99129 Aetna Health Inc. (a PA corp.) IL Not Eligible $ - $(370,976.96)

72547 Aetna Life Insurance Company IL $917,024.20 $125,878.03 $(719,734.14)

36096 Blue Cross Blue Shield of Illinois IL $277,945,707.24 $(10,823,647.68) $4,303,605.47

27833 Celtic Insurance Company IL $0.00 $15,156.60 $ -

35670 Coventry Health & Life Co. IL $2,168,704.98 $(2,604,833.08) $(400,513.48)

96601 Coventry Health Care of Illinois, Inc. IL $6,155,110.05 $(3,262,695.30) $(1,048,560.53)

66143 Federated Mutual Insurance Company IL Not Eligible $ - $(390,516.48)

82506 Freedom Life Insurance IL $57,607.05 $59,844.74 $ -


20129 Health Alliance Medical Plans, Inc. IL $4,530,888.45 $2,597,374.35 $(998,963.73)

58288 Humana Health Plan, Inc. IL $1,960,712.58 $614,409.67 $(1,028,302.66)

68303 Humana Insurance Company IL $8,159,410.80 $8,268,175.79 $4,255,065.52

57020 John Alden Life Insurance Company IL Not Eligible $ - $183,726.24

79763 Land of Lincoln Mutual Health Insurance Company IL $4,808,906.25 $816,860.44 $(390,929.05)

59311 Madison National Life IL Not Eligible $ - $(3,535.77)

24301 Medical Associates Health Plans IL Not Eligible $ - $(131,881.33)

53586 Nippon Life Insurance Company of America IL Not Eligible $ - $(42,724.33)

18389 Pekin Life Insurance Company IL Not Eligible $ - $(52,688.31)

40448 Standard Security Life IL Not Eligible $ - $(28.68)

67807 Time Insurance Company IL $6,649,598.67 $4,193,476.50 $20,402.52

92476 UnitedHealthcare Ins Co of Illinois IL Not Eligible $ - $(700,664.41)

34446 UnitedHealthcare Ins Co of River Valley IL Not Eligible $ - $(1,540,017.03)

42529 UnitedHealthcare of Illinois, Inc. IL Not Eligible $ - $(724,765.70)

58239 UnitedHealthcare Plan of the River Valley, Inc. IL Not Eligible $ - $(217,997.08)

32378 Aetna Life Insurance Company IN Not Eligible $ - $(649,454.74)

36373 All Savers Insurance Company IN Not Eligible $ - $(425,165.15)

17575 Anthem Ins Companies Inc(Anthem BCBS) IN $63,611,127.93 $(35,299,047.70) $5,862,596.41

76179 Celtic Insurance Company IN $0.00 $(7,885.97) $ -

35065 Coordinated Care Corporation Indiana IN $102,697.05 $(323,051.82) $ -

11104 Federated Mutual Insurance Company IN Not Eligible $ - $(22,411.92)

43442 Humana Health Plan IN Not Eligible $ - $ (19,667.22)

99791 Humana Insurance Company IN $15,636,033.12 $12,712,802.22 $28,264.72

95074 John Alden Life Insurance Company IN Not Eligible $ - $(124,424.43)

85320 MDwise, Inc. IN $17,158,478.60 $18,423,632.06 $ -


43499 Medical Mutual of Ohio IN Not Eligible $ - $(265,136.19)

98761 Nippon Life Insurance Company of America IN Not Eligible $ - $(117,653.72)

79828 Pekin Life Insurance Company IN Not Eligible $ - $(71,406.41)

50816 Physicians Health Plan of Northern Indiana, Inc. IN $10,350,382.87 $(4,011,882.59) $115,029.27

67920 Southeastern Indiana Health Organization IN Not Eligible $ - $(840,621.54)

50442 Standard Security Life IN Not Eligible $ - $(17,085.65)

91842 Time Insurance Company IN $15,491,452.97 $8,505,433.96 $(90,416.73)

62052 Trustmark Life Insurance Company IN Not Eligible $ - $39,262.67

72850 UnitedHealthcare Insurance Company IN Not Eligible $ - $(3,241,006.75)

35755 US HEALTH AND LIFE INSURANCE COMPANY IN Not Eligible $ - $(160,702.61)

84600 Aetna Life Insurance Company KS Not Eligible $ - $(266,018.93)

94248 Blue Cross and Blue Shield of Kansas City KS $11,523,299.72 $8,092,802.17 $1,450,193.47

18558 Blue Cross and Blue Shield of Kansas, Inc. KS $25,958,565.69 $7,698,173.07 $1,056,774.58

34368 Celtic Insurance Company KS $0.00 $3,792.70 $ -

61430 Coventry Health and Life KS $18,150,600.47 $(10,156,545.50) $(84,693.06)

65598 Coventry Health Care Of Kansas Inc KS $6,787,834.35 $(5,910,292.03) $(713,955.94)

96352 Federated Mutual Insurance Company KS Not Eligible $ - $(171,528.97)

54822 Freedom Life Insurance KS $0.00 $(230.08) $ -

49857 Humana Health Plan, Inc. KS Not Eligible $ - $(125,193.09)

19968 Humana Insurance Company KS $385,045.35 $97,760.97 $(291,686.41)

98618 John Alden Life Insurance Company KS Not Eligible $ - $(75,807.36)

71122 Time Insurance Company KS $2,664,586.18 $174,538.76 $(9,478.41)

94968 UnitedHealthcare Insurance Company KS Not Eligible $ - $(768,605.82)

77029 All Savers Insurance Company KY Not Eligible $ - $(3,311.90)

36239 Anthem Health Plans of KY(Anthem BCBS) KY $10,851,899.04 $4,889,935.19 $2,798,476.94


40586 Bluegrass Family Health, Inc. KY Not Eligible $ - $(1,254,224.27)

15411 Humana Health Plan, Inc. KY $8,010,148.24 $1,152,387.48 $(1,929,958.70)

33734 John Alden Life Insurance Company KY Not Eligible $ - $(22,525.81)

77894 Kentucky Health Cooperative KY $58,246,745.30 $(7,829,059.51) $(49,429.47)

19503 Time Insurance Company KY $2,528,454.66 $1,786,736.84 $196,961.32

23671 UnitedHealthcare of Kentucky, Ltd. KY Not Eligible $ - $312,802.38

45920 UnitedHealthcare of Ohio, Inc. KY Not Eligible $ - $(48,790.45)

81941 Aetna Health Inc. (a LA corp.) LA $1,125,984.52 $(2,764,603.70) $(120,226.85)

14030 Aetna Life Insurance Company LA Not Eligible $ - $(11,121.47)

93653 All Savers Insurance Company LA Not Eligible $ - $(6,296.82)

22381 Coventry Health and Life LA Not Eligible $ - $(37,335.05)

19913 Freedom Life Insurance LA $0.00 $72,093.27 $ -

19636 HMO Louisiana, Inc. LA $11,532,268.15 $(12,245,987.34) $(674,763.59)

44965 Humana Health Benefit Plan of Louisiana, Inc. LA $8,126,454.76 $482,642.43 $(119,935.54)

89219 John Alden Life Insurance Company LA Not Eligible $ - $(23,667.98)

67202 Louisiana Health Cooperative, Inc. LA $9,878,052.34 $(7,456,986.26) $(36,621.89)

97176 Louisiana Health Service & Indemnity Company LA $59,187,419.01 $22,005,546.46 $803,668.20

31434 Time Insurance Company LA $1,428,188.05 $323,444.34 $8,246.81

69842 UnitedHealthcare Insurance Company LA Not Eligible $ - $511,621.86

38499 UnitedHealthcare of Louisiana, Inc. LA Not Eligible $ - $(97,687.22)

67243 Vantage Health Plan, Inc. LA $5,014,154.17 $(416,149.30) $(195,880.47)

42690 Blue Cross and Blue Shield

of Massachusetts HMO Blue, Inc. ***

MA $37,222,783.00 N/A – MA Issuer N/A – MA Issuer

24675 Blue Cross and Blue Shield of Massachusetts, Inc. *** MA $78,976.66 N/A – MA Issuer N/A – MA Issuer

82569 Boston Medical Center Health Plan, Inc. *** MA $130,830.24 N/A – MA Issuer N/A – MA Issuer


31234 CeltiCare Health Plan of MA*** MA $0.00 N/A – MA Issuer N/A – MA Issuer

88950 ConnectiCare of Massachusetts, Inc. *** MA $0.00 N/A – MA Issuer N/A – MA Issuer

88806 Fallon Community Health Plan, Inc. *** MA $2,543,005.00 N/A – MA Issuer N/A – MA Issuer

52710 Fallon Health & Life Assurance Company*** MA $51,087.41 N/A – MA Issuer N/A – MA Issuer

36046 Harvard Pilgrim Health Care Inc. *** MA $9,694,228.25 N/A – MA Issuer N/A – MA Issuer

34484 Health New England, Inc. *** MA $774,704.21 N/A – MA Issuer N/A – MA Issuer

95878 HPHC Insurance Company Inc. *** MA $2,225,269.37 N/A – MA Issuer N/A – MA Issuer

73331 Minuteman Health, Inc.*** MA $1,167.60 N/A – MA Issuer N/A – MA Issuer

41304 Neighborhood Health Plan*** MA $11,225,924.12 N/A – MA Issuer N/A – MA Issuer

29125 Tufts Associated Health Maintenance Org*** MA $9,896,287.04 N/A – MA Issuer N/A – MA Issuer

59763 Tufts Health Public Plans Inc. *** MA $116,022.27 N/A – MA Issuer N/A – MA Issuer

38712 Tufts Insurance Company*** MA $1,677,442.23 N/A – MA Issuer N/A – MA Issuer

31779 UnitedHealthcare Insurance Company*** MA $0.00 N/A – MA Issuer N/A – MA Issuer

66516 Aetna Health Inc. (a PA corp.) MD Not Eligible $ - $11,143.81

70767 Aetna Life Insurance Company MD Not Eligible $ - $85,307.78

36677 All Savers Insurance Company MD $266,389.22 $272,660.90 $ -

28137 CareFirst BlueChoice, Inc. MD $33,674,052.57 $(12,598,519.03) $(4,834,145.80)

45532 CareFirst of Maryland, Inc. MD $21,694,659.41 $9,718,734.15 $3,249,730.99

68541 Coventry Health and Life MD Not Eligible $ - $(1,991,429.33)

14468 Coventry Health Care of Delaware, Inc. MD Not Eligible $ - $(4,255,487.55)

72564 Evergreen Health Cooperative, Inc. MD $311,875.67 $(360,466.32) $ -

94084 GHMSI MD $9,970,292.23 $5,177,916.02 $5,641,971.56


States, Inc. MD $1,405,157.30 $(2,210,325.79) $773,138.57

65635 MAMSI Life and Health Insurance Company MD Not Eligible $ - $860,842.04


72375 Optimum Choice, Inc. MD Not Eligible $ - $(765,269.83)

23620 UnitedHealthcare Insurance Company MD Not Eligible $ - $1,556,233.82

31112 UnitedHealthcare of the Mid-Atlantic Inc. MD Not Eligible $ - $(332,036.00)

53357 Aetna Life Insurance Company ME Not Eligible $ - $(2,225,221.04)

48396 Anthem Health Plans of ME(Anthem BCBS) ME $5,456,360.21 $363,457.73 $2,604,015.24

96667 Harvard Pilgrim Health Care Inc. ME $41,057.31 $(72,007.16) $(814,362.12)

11593 HPHC Insurance Company Inc. ME $754,640.17 $578,793.75 $347,234.34

33653 Maine Community Health Options ME $35,448,310.19 $(926,811.51) $97,813.31

85076 The MEGA Life and Health Insurance Company ME $205,000.00 $56,567.18 $ -

90214 UnitedHealthcare Insurance Company ME Not Eligible $ - $(9,479.76)

81068 Aetna Life Insurance Company MI $379,492.96 $(299,479.55) $ -

52670 All Savers Insurance Company MI Not Eligible $ - $(19,155.16)

67577 Alliance Health and Life Insurance Company MI $2,529,564.79 $1,895,578.59 $(181,245.97)

98185 Blue Care Network of Michigan MI $54,508,071.26 $(47,134,095.64) $(5,484,016.17)

15560 Blue Cross Blue Shield of

Michigan Mutual Insurance Company

MI $104,173,592.81 $67,492,960.02 $13,529,304.35

35443 Celtic Insurance Company MI $0.00 $(633.00) $ -

41895 Consumers Mutual Insurance of Michigan MI $252,541.02 $122,480.23 $(1,252,756.84)

82649 Federated Mutual Insurance Company MI Not Eligible $ - $(1,658,184.03)

37651 Health Alliance Plan (HAP) MI $5,921,541.69 $5,267,035.16 $(59,049.89)

59830 HealthPlus Insurance Company MI $8,257,698.56 $(3,647,377.54) $(322,954.15)

13667 HealthPlus of Michigan MI $1,384,234.63 $(855,252.76) $(366,651.02)

62294 Humana Insurance Company MI $702,964.71 $884,115.01 $(107,913.09)

46275 Humana Medical Plan of Michigan, Inc. MI $7,997,890.20 $(25,129,449.51) $ -

79970 John Alden Life Insurance Company MI Not Eligible $ - $(155,335.89)


20393 McLaren Health Plan MI $1,865,110.37 $(275,686.71) $480,378.30

58594 Meridian Health Plan of Michigan, Inc. MI $0.00 $(23,501.09) $ -

40047 Molina Healthcare of Michigan, Inc. MI $0.00 $6,332.08 $ -

59140 Nippon Life Insurance Company of America MI Not Eligible $ - $(29,795.04)

23592 Paramount Care of Michigan MI Not Eligible $ - $130,383.94

95233 Paramount Insurance Company MI Not Eligible $ - $(53,820.30)

20662 PHP Insurance Company MI Not Eligible $ - $(127,949.20)

60829 Physicians Health Plan MI $0.00 $(76,724.32) $(681,491.41)

29698 Priority Health MI $4,982,858.59 $1,058,987.28 $(1,528,301.43)

29241 Priority Health Insurance Company (PHIC) MI $1,980,226.36 $1,869,040.06 $267,097.25

89029 Time Insurance Company MI $2,196,259.12 $688,700.17 $(60,605.89)

67183 Total Health Care USA, Inc. MI $2,025,795.65 $(1,099,668.46) $(1,225,249.24)

63631 UnitedHealthcare Insurance Company MI Not Eligible $ - $(1,087,425.35)

45002 UnitedHealthcare Life Insurance Company MI $1,080,097.07 $(743,360.22) $(2,483.96)

58996 US HEALTH AND LIFE INSURANCE COMPANY MI Not Eligible $ - $(2,779.82)

49316 BCBSM, INC. MN $117,276,163.56 $7,616,924.44 $11,759,377.10

60769 Federated Mutual Insurance Company MN Not Eligible $ - $(2,090,475.15)

34102 Group Health Plan, Inc. MN $2,695,282.74 $(2,650.50) $ -

70373 Gundersen Health Plan Minnesota, Inc. MN $74,310.37 $32,683.14 $ (97,647.51)

85654 HealthPartners Insurance Company MN $10,273,153.62 $(5,217,351.16) $(820,791.54)

79888 HealthPartners, Inc. MN $1,402,532.92 $2,384,614.40 $(4,200,533.56)

56971 John Alden Life Insurance Company MN $2,783.90 $(46,632.10) $113,761.56

65847 Medica Health Plans of Wisconsin MN $2,670,519.49 $130,710.53 $ -

31616 Medica Insurance Company MN $8,295,441.04 $ (11,637,872.80) $(4,213,354.17)

97624 PreferredOne Community Health Plan MN Not Eligible $ - $637,606.26


88102 PreferredOne Insurance Company MN $51,337,471.78 $5,422,835.32 $(1,029,344.47)

52346 Sanford Health Plan of Minnesota MN Not Eligible $ - $(20,085.39)

27439 Time Insurance Company MN $3,434,347.41 $388,993.92 $(38,513.10)

85736 UCare Minnesota MN $311,887.29 $927,744.90 $ -

32898 Aetna Health Inc. (a PA corp.) MO Not Eligible $ - $(10,219.44)

48161 Aetna Life Insurance Company MO Not Eligible $ - $228,766.81

34762 Blue Cross and Blue Shield of Kansas City MO $25,923,279.05 $18,053,572.29 $2,682,326.20

99723 Celtic Insurance Company MO $0.00 $(4,177.67) $ -

44527 Coventry Health & Life Insurance Co. MO $30,510,642.69 $947,089.73 $ -

44240 Coventry Health and Life MO $36,558,693.78 $(16,394,921.63) $308,569.39

96384 Cox Health Systems Insurance Company MO $1,265,068.01 $(173,675.23) $(164,283.18)

64701 Federated Mutual Insurance Company MO Not Eligible $ - $(752,603.40)

32753 Healthy Alliance Life Co(Anthem BCBS) MO $31,718,277.28 $(5,335,441.08) $(3,154,909.68)

92766 HMO Missouri, Inc.(Anthem BCBS) MO Not Eligible $ - $(339,677.71)

30613 Humana Insurance Company MO $2,236,587.76 $(545,487.55) $1,697,620.38

49221 John Alden Life Insurance Company MO Not Eligible $ - $(89,587.28)

12363 Standard Security Life MO Not Eligible $ - $(1,744.73)

14026 Time Insurance Company MO $5,677,768.05 $2,064,658.36 $(12,141.44)

27401 Trustmark Life Insurance Company MO Not Eligible $ - $(49,295.41)

95426 UnitedHealthcare Insurance Company MO Not Eligible $ - $(342,820.74)

14162 UnitedHealthcare Life Insurance Company MO $2,019,769.19 $1,388,382.82 $ -

26781 All Savers Insurance Company MS Not Eligible $ - $(50,551.73)

11721 Blue Cross & Blue Shield of Mississippi MS $6,452,872.90 $4,539,847.85 $356,245.91

83808 Coventry Health and Life MS $0.00 $(132,911.30) $16,718.65

38420 Federated Mutual Insurance Company MS Not Eligible $ - $(32,739.65)


96734 Freedom Life Insurance MS $0.00 $48,146.28 $ -

48963 Humana Insurance Company MS $26,027,575.11 $1,064,234.77 $(492,484.94)

49900 John Alden Life Insurance Company MS Not Eligible $ - $(59,314.70)

94237 Magnolia Health Plan MS $2,481,685.51 $(6,560,626.86) $ -

45521 Time Insurance Company MS $2,150,624.77 $1,041,309.44 $(54,781.44)

98805 UnitedHealthcare Insurance Company MS Not Eligible $ - $266,871.28

61794 UnitedHealthcare Life Insurance Company MS Not Eligible $ - $1,295.50

97560 UnitedHealthcare of Mississippi, Inc. MS Not Eligible $ - $48,741.10

30751 Blue Cross and Blue Shield of Montana MT $39,734,997.94 $(4,280,629.18) $(250,657.20)

16621 Celtic Insurance Company MT $0.00 $(586.80) $ -

63342 Independence American Ins Co MT Not Eligible $ - $(14,700.32)

64206 John Alden Life Insurance Company MT Not Eligible $ - $(292,758.82)

49669 Madison National Life MT Not Eligible $ - $(24,720.97)

32225 Montana Health Cooperative MT $10,821,501.27 $3,157,443.90 $297,652.03

23603 PacificSource Health Plans MT $6,099,996.76 $506,533.42 $285,047.68

24867 Time Insurance Company MT $3,474,683.03 $617,238.69 $(32,953.83)

46621 UnitedHealthcare Insurance Company MT Not Eligible $ - $33,091.48

61671 Aetna Health Inc. (a PA corp.) NC Not Eligible $ - $207,989.26

61644 Aetna Life Insurance Company NC $215,718.92 $(240,838.67) $205,830.47

72487 All Savers Insurance Company NC Not Eligible $ - $(30,949.45)

11512 Blue Cross and Blue Shield of NC NC $263,678,345.72 $21,858,789.45 $9,263,138.01

44007 Celtic Insurance Company NC $0.00 $7,337.57 $ -

40411 Cigna Health and Life Insurance Company NC $1,242,110.42 $1,069,804.73 $ -

94459 Coventry Health & Life Insurance Company NC Not Eligible $ - $(206,038.72)

56346 Coventry Health Care of the Carolinas, Inc. NC $24,984,866.80 $(22,133,565.21) $(7,310,102.87)


24588 Federated Mutual Insurance Company NC Not Eligible $ - $(269,581.82)

43283 FirstCarolinaCare Insurance Company NC Not Eligible $ - $407.05

32237 Humana Insurance Company NC $115,720.45 $(458,922.56) $(9,900.45)

59977 John Alden Life Insurance Company NC $0.00 $(115,565.12) $(40,668.98)

76871 Standard Security Life NC Not Eligible $ - $(4,277.28)

87696 Time Insurance Company NC $2,823,899.85 $ 12,959.79 $(109,748.65)

58658 UnitedHealthcare Ins Co of River Valley NC Not Eligible $ - $(1,228,032.54)

69347 UnitedHealthcare Insurance Company NC Not Eligible $ - $(15,874.11)

54332 UnitedHealthcare of North Carolina, Inc NC Not Eligible $ - $(452,189.72)

37160 Blue Cross Blue Shield of North Dakota ND $13,433,148.25 $1,088,177.61 $309,402.76

99806 John Alden Life Insurance Company ND Not Eligible $ - $(8,542.70)

73751 Medica Health Plans ND $1,073,377.89 $(807,481.69) $(105,459.46)

39364 Medica Insurance Company ND Not Eligible $ - $(987,988.94)

89364 Sanford Health Plan ND $300,927.77 $128,336.66 $871,040.84

55105 Time Insurance Company ND $376,302.04 $(409,032.49) $(78,452.51)

29678 Blue Cross and Blue Shield of Nebraska NE $38,604,318.76 $1,379,197.77 $3,588,744.99

43198 CoOportunity Health NE $46,800,412.98 $(3,258,008.03) $(3,208,840.42)

79636 Coventry Health and Life Insurance Co. NE $0.00 $58,981.49 $(51,592.75)

15438 Coventry Health Care of Nebraska Inc. NE $2,189,015.61 $1,102,852.31 $(43,854.16)

47340 Federated Mutual Insurance Company NE Not Eligible $ - $(43,990.66)

77931 Health Alliance Midwest Inc. NE $51,463.87 $62,479.01 $(9,965.96)

81966 Humana Insurance Company NE Not Eligible $ - $9,531.18

80698 John Alden Life Insurance Company NE Not Eligible $ - $71,939.33

89156 Standard Security Life NE Not Eligible $ - $(3,265.91)

19524 Time Insurance Company NE $2,775,559.37 $654,497.47 $128,514.67


73102 UnitedHealthcare Insurance Company NE Not Eligible $ - $(437,220.34)

57601 Anthem Health Plans of NH(Anthem BCBS) NH Not Eligible $ - $1,238,434.39

75841 Celtic Insurance Company NH $100,260.25 $57,417.02 $ -

59025 Harvard Pilgrim Health Care of NE NH Not Eligible $ - $(2,973,746.39)

71616 HPHC Insurance Company, Inc NH Not Eligible $ - $1,521,697.59

96751 Matthew Thornton Hlth Plan(Anthem BCBS) NH $15,647,565.30 $(5,300,321.87) $182,178.31

42260 Time Insurance Company NH $6,063,182.46 $5,242,904.85 $ -

51889 UnitedHealthcare Insurance Company NH Not Eligible $ - $31,436.05

82884 Aetna Health Inc. (a NJ corp.) NJ Not Eligible $ - $(4,701,905.74)

89217 Aetna Life Insurance Company NJ $6,801,229.68 $8,237,729.61 $2,281,721.44

77606 AmeriHealth HMO, Inc. NJ $14,451,039.66 $(24,131,946.51) $(7,051,442.97)

91762 AmeriHealth Ins Company of New Jersey NJ $62,373,022.13 $(22,931,262.46) $(9,401,983.10)

23458 Cigna Health and Life Insurance Company NJ Not Eligible $ - $67,014.80

41014 Cigna HealthCare of New Jersey, Inc. NJ $186,497.63 $360,117.31 $27,532.67

10191 Freelancers CO-OP of New Jersey, Inc. NJ $5,827,111.77 $8,485,218.90 $(615,255.45)

13953 Horizon Healthcare of New Jersey, Inc. NJ Not Eligible $ - $97,615.72

91661 Horizon Healthcare Services, Inc. NJ $68,139,576.15 $(13,375,799.26) $10,604,745.48

77263 Oxford Health Insurance, Inc. NJ $14,105,003.88 $32,903,691.30 $8,812,791.52

48834 Oxford Health Plans (NJ), Inc. NJ $5,793,980.12 $10,452,251.14 $(120,834.31)

75605 Blue Cross Blue Shield of New Mexico NM $17,360,787.26 $6,258,751.86 $1,212,948.58

97132 Lovelace Health System, Inc. NM $106,022.49 $113,433.56 $336,586.34

19722 Molina Health Care of New Mexico, Inc. NM $325,293.64 $685,619.88 $ -

93091 New Mexico Health Connections NM $3,178,238.43 $(4,834,621.72) $(1,832,176.28)

57173 Presbyterian Health Plan, Inc. NM $6,125,158.70 $ (2,442,724.87) $748,544.00

52744 Presbyterian Insurance Company, Inc. NM Not Eligible $ - $211,847.75


97646 Time Insurance Company NM $205,000.00 $219,541.22 $ -

90762 UnitedHealthcare Insurance Company NM Not Eligible $ - $(677,750.41)

19298 Aetna Health Inc. (a PA corp.) NV Not Eligible $ - $8,649.73

65779 Aetna Health of Utah Inc. NV $0.00 $(1,158,344.59) $(16,246.63)

27990 Aetna Life Insurance Company NV $626,982.29 $(401,883.36) $(1,140,094.88)

68307 Celtic Insurance Company NV $0.00 $(8,625.15) $ -

49021 Coventry Health & Life Insurance Company NV $145,981.41 $(1,015,221.06) $(385,400.28)

95865 Health Plan of Nevada, Inc. NV $5,762,413.99 $(3,030,918.47) $2,092,880.93

60156 HMO Colorado, Inc., dba HMO Nevada NV $4,285,648.85 $(4,049,114.37) $(140,898.78)

41094 HOMETOWN HEALTH PLAN, INC NV Not Eligible $ - $(275,961.08)

85266 HOMETOWN HEALTH PROVIDERS INS. CO.

INC. NV $234,356.21 $248,604.41 $(318,074.62)

93696 Humana Health Plan Inc. NV Not Eligible $ - $(76,054.90)

20895 Humana Insurance Company NV $2,544,443.97 $1,873,080.72 $(358,637.74)

87446 John Alden Life Insurance Company NV Not Eligible $ - $(153,107.91)

34996 Nevada Health CO-OP NV $10,078,725.11 $(3,289,885.24) $(340,005.25)

16698 Prominence HealthFirst NV $3,231,609.73 $542,628.00 $(844,787.93)

68524 Prominence Preferred Health Insurance Company, Inc. NV Not Eligible $ - $419,362.27

33670

Rocky Mountain Hospital and Medical Service, Inc.,

dba Anthem Blue Cross and Blue Shield

NV Not Eligible $ - $396,272.46

83198 Sierra Health and Life Ins Company, Inc. NV $6,624,972.17 $6,879,575.41 $2,637,752.16

29211 Time Insurance Company NV $10,011,393.67 $3,410,103.71 $(633,561.00)

74222 UnitedHealthcare Insurance Company NV Not Eligible $ - $(872,086.46)

50138 Aetna Health Inc. (a NY corp.) NY Not Eligible $ - $(440,146.89)

17210 Aetna Life Insurance Company NY $14,663,439.86 $14,975,558.90 $(62,207,250.53)

57165 Affinity Health Plan, Inc. NY $464,860.50 $(2,141,766.08) $ -


31808 American Progressive Life

& Health Insurance Company of New York

NY $547,364.03 $660,761.45 $ -

49526 BlueCross BlueShield of Western New York NY $3,203,677.59 $8,494,368.23 $12,158,210.88

36346 BlueShield of Northeastern New York NY $146,646.58 $347,650.52 $992,090.05

94788 CDPHP NY $5,393,821.37 $8,365,330.23 $5,699,384.43

92551 CDPHP Universal Benefits Inc. NY Not Eligible $ - $(1,425,321.82)

44113 Empire HealthChoice Assurance, Inc. NY Not Eligible $ - $(2,505,396.90)

80519 Empire HealthChoice HMO, Inc. NY $38,100,183.86 $(4,215,356.78) $(7,974,099.79)

78124 Excellus Health Plan, Inc. NY $25,521,165.66 $33,519,366.16 $26,430,399.01

71644

Freelancers Health Service Corporation d/b/a Health

Republic Insurance of New York

NY $58,217,806.98 $(28,222,332.50) $(52,013,211.07)

58707 Freelancers Insurance Company, Inc. NY $683,731.81 $(426,177.20) $ -

88000 Group Health Incorporated NY $259,152.62 $(1,025.08) $11,794.91

88582 Health Insurance Plan of Greater New York NY $24,545,381.34 $(3,859,201.90) $(29,376,578.45)

91237 Healthfirst PHSP, Inc. NY $4,031,460.89 $(2,649,557.85) $ -

40064 HealthNow New York NY $0.00 $(9,077.56) $(54,673.38)

70552 Independent Health Association, Inc NY Not Eligible $ - $287,516.92

18029 Independent Health Benefits Corporation NY $2,866,728.88 $6,203,465.48 $4,211,250.12

83744 Managed Health, Inc. NY Not Eligible $ - $(162,614.90)

11177 MetroPlus Health Plan NY $4,200,475.38 $(54,033,594.10) $(1,169,658.09)

56184 MVP Health Plan, Inc. NY $20,053,742.68 $11,938,998.21 $(2,812,217.01)

89846 MVP Health Services Corp. NY Not Eligible $ - $(241,575.58)

25303 New York State Catholic Health Plan, Inc. NY $13,745,380.71 $(37,511,467.39) $ -

82483 North Shore-LIJ Insurance Company Inc NY $5,931,474.35 $434,621.91 $(735,698.81)

74289 Oscar Insurance Corporation NY $17,524,068.75 $(8,073,821.58) $ -


85629 Oxford Health Insurance, Inc. NY Not Eligible $ - $145,248,013.80

26420 Oxford Health Plans (NY), Inc. NY $37,810,243.67 $51,416,066.70 $(33,465,842.73)

54297 UnitedHealthcare Ins Co of New York NY Not Eligible $ - $(454,374.00)

54235 UnitedHealthcare of New York, Inc. NY $9,905,407.05 $ 4,787,190.35 $ -

84867 Aetna Health Inc. (a PA corp.) OH Not Eligible $ - $(1,613,799.56)

67129 Aetna Life Insurance Company OH $753,385.30 $(225,186.77) $(593,316.79)

28162 AultCare Insurance Company OH $3,286,427.05 $(174,769.08) $382.29

41047 Buckeye Community Health Plan OH $311,415.92 $(154,350.05) $ -

77552 CareSource OH $7,007,426.04 $(2,165,055.80) $ -

62352 Celtic Insurance Company OH $0.00 $(6,348.32) $ -

29276 Community Insurance Company(Anthem BCBS) OH $29,350,337.77 $4,108,227.93 $7,243,843.64

16204 Coordinated Health Mutual, Inc. OH $929,483.49 $(1,262,069.95) $(2,121,774.30)

98894 Coventry Health and Life OH $3,632,204.94 $(2,282,003.25) $(555,698.91)

96800 Federated Mutual Insurance Company OH Not Eligible $ - $(264,945.16)

92036 HealthSpan OH $2,399,677.86 $(4,194,646.37) $(11,076.66)

20126 HealthSpan Integrated Care OH $2,879,588.73 $(9,566,203.90) $(3,621,911.77)

66083 Humana Health Plan of Ohio, Inc. OH $9,065,689.80 $(6,379,256.85) $683,165.75

97596 Humana Insurance Company OH $1,469,495.12 $976,968.60 $(210,554.64)

50498 John Alden Life Insurance Company OH Not Eligible $ - $6,795.41

99969 Medical Health Insuring Corp. of Ohio OH $45,396,359.92 $9,233,566.61 $(614,504.61)

80627 Medical Mutual of Ohio OH $36,995,018.15 $9,369,568.40 $1,218,032.80

64353 MOLINA HEALTHCARE OF OHIO OH $20,238.70 $180,648.95 $ -

56073 Nippon Life Insurance Company of America OH Not Eligible $ - $(200,278.30)

74313 Paramount Insurance Company OH $1,327,983.05 $(389,493.94) $(528,876.15)

76169 Standard Security Life OH Not Eligible $ - $(28,737.96)


52664 Summa Insurance Company, Inc. OH $4,527,307.52 $(360,679.09) $1,182,289.72

83396 The Health Plan of the Upper Ohio Valley OH $0.00 $37,488.57 $(262,670.99)

98810 THP Insurance Company OH Not Eligible $ - $65,903.79

14650 Time Insurance Company OH $4,474,174.84 $2,104,210.85 $66,259.04

33232 UnitedHealthcare Ins Co of River Valley OH Not Eligible $ - $(1,094,386.45)

56726 UnitedHealthcare Insurance Company OH Not Eligible $ - $2,231,396.77

61724 UnitedHealthcare Life Insurance Company OH $907,441.89 $1,149,383.33 $(975,536.98)

76275 Aetna Health Inc. (a PA corp.) OK Not Eligible $ - $(69,215.87)

66946 Aetna Life Insurance Company OK $146,161.64 $178,252.53 $(174,947.03)

87571 Blue Cross Blue Shield of Oklahoma OK $58,988,045.78 $(912,836.76) $5,538,080.47

62505 Celtic Insurance Company OK $0.00 $(7,794.93) $ -

98905 CommunityCare HMO Inc. OK $424,071.17 $823,116.30 $(1,245,374.77)

87698 CommunityCare Life & Health Insurance Co OK Not Eligible $ - $(437,673.74)

53524 Coventry Health and Life OK $548,214.67 $(322,539.29) $(977,664.58)

76668 Coventry Health Care of Kansas, Inc. OK $1,231,282.68 $(1,090,288.81) $6,653.02

27243 Federated Mutual Insurance Company OK Not Eligible $ - $(117,688.70)

82209 Freedom Life Insurance OK $0.00 $(853.44) $ -

85408 GlobalHealth, Inc. OK $2,086,448.06 $508,909.92 $(15,049.88)

23468 Humana Insurance Company OK $55,344.03 $(107,296.38) $(81,323.21)

67088 John Alden Life Insurance Company OK Not Eligible $ - $(198,017.77)

29176 Time Insurance Company OK $3,742,479.01 $847,618.04 $29,114.13

85757 UnitedHealthcare Insurance Company OK Not Eligible $ - $(2,256,892.13)

98704 UnitedHealthcare Life Insurance Company OK $1,369,617.06 $83,712.74 $ -

32536 ATRIO Health Plans OR $316.53 $5,124.77 $(16,819.77)

63474 BridgeSpan Health Company OR $0.00 $16,568.71 $ -


99389 Community Care of Oregon, Inc. OR $620,828.68 $961,182.24 $(356,550.41)

10940 Health Net Health Plan of Oregon, Inc. OR $3,230,190.41 $2,794,804.37 $(2,324,193.93)

96383 Health Republic Insurance Company OR $4,065,274.13 $1,765,810.56 $(3,017,355.70)

71287 Kaiser Foundation Healthplan of the NW OR $9,896,905.63 $12,000,350.41 $2,516,711.91

85804 LifeWise Health Plan of Oregon OR $8,722,377.76 $2,582,812.50 $550,216.10

39424 Moda Health Plan, Inc. OR $110,546,514.06 $(31,157,398.15) $(4,604,925.33)

10091 PacificSource Health Plans OR $10,421,046.15 $3,133,280.74 $359,543.94

56707 Providence Health Plan OR $8,094,883.08 $2,963,920.51 $1,673,687.32

77969 Regence BlueCross BlueShield of Oregon OR $10,846,173.39 $4,080,269.20 $6,543,460.93

74571 Time Insurance Company OR $2,747,472.78 $855,887.67 $ -

95417 Trillium Community Health Plan OR $0.00 $(2,613.45) $ -

59129 Trustmark Life Insurance Company OR Not Eligible $ - $(13,431.59)

90175 UnitedHealthcare Insurance Company OR Not Eligible $ - $(1,310,343.26)

64844 Aetna Health Inc. (a PA corp.) PA $1,280,386.05 $(1,144,736.65) $(3,059,493.02)

33906 Aetna Life Insurance Company PA $2,951,625.54 $(67,222.42) $(382,153.41)

45127 Capital Advantage Assurance Company PA $276,428.37 $395,776.73 $5,977,678.07

82795 Capital Advantage Insurance Company CAIC PA $4,230,862.57 $3,395,486.14 $(38,116.73)

10842 Celtic Insurance Company PA $0.00 $(6,140.62) $ -

80148 Federated Mutual Insurance Company PA Not Eligible $ - $(405,353.24)

55957 First Priority Life Insurance Company, Inc. PA $19,949,105.81 $585,146.21 $1,050,494.99

22444 Geisinger Health Plan PA $14,765,963.46 $1,759,834.57 $(6,627,591.76)

75729 Geisinger Quality Options PA $2,772,466.89 $490,533.38 $(2,827,499.00)

91303 HealthAmerica Pennsylvania, Inc. PA $2,150,140.52 $(1,253,464.22) $ -

93838 HealthAssurance PA, Inc PA Not Eligible $ - $(1,641,283.35)

70194 Highmark Health Insurance Company PA $59,657,176.61 $42,359,592.09 $5,446,786.21


33709 Highmark Inc. PA $97,340,297.04 $(44,238,595.47) $(4,503,418.41)

31609 Independence Blue Cross (QCC Ins. Co.) PA $67,630,617.15 $50,795,145.81 $13,315,931.52

48788 Inter-County Hospital Plan PA Not Eligible $ - $(818,247.52)

58819 John Alden Life Insurance Company PA Not Eligible $ - $(78,133.65)

53789 Keystone Health Plan Central PA $1,122,656.96 $238,390.33 $(78,244.77)

33871 Keystone Health Plan East, Inc PA $56,237,853.67 $(61,020,486.20) $(7,900,229.63)

38949 Keystone Health Plan West PA $304,443.33 $223,700.41 $(59,934.41)

19068 Time Insurance Company PA $4,662,824.37 $1,461,479.59 $(220,045.83)

23489 UnitedHealthcare Insurance Company PA Not Eligible $ - $(2,928,219.72)

45404 UnitedHealthcare Life Insurance Company PA $1,124,049.95 $798,351.41 $ -

62560 UPMC Health Coverage, Inc. PA $2,349,715.64 $2,366,387.54 $480,494.03

16481 UPMC Health Network, Inc. PA $919,524.99 $541,631.59 $1,137,929.73

16322 UPMC Health Options, Inc. PA $24,576.34 $(3,587.19) $3,575,646.12

52899 UPMC Health Plan, Inc. PA $2,076,697.34 $2,322,777.07 $583,003.78

15287 Blue Cross & Blue Shield of Rhode Island RI $23,394,916.92 $570,729.73 $2,903,419.54

77514 Neighborhood Health Plan of Rhode Island RI $22,152.30 $(570,729.75) $(28,800.70)

90010 Tufts Associated Health Maintenance Org RI Not Eligible $ - $(192,657.68)

26322 Tufts Insurance Company RI Not Eligible $ - $159,121.32

90117 UnitedHealthcare Insurance Company RI Not Eligible $ - $(1,740,424.21)

79881 UnitedHealthcare of New England, Inc. RI Not Eligible $ - $(1,100,658.25)

22369 Aetna Life Insurance Company SC Not Eligible $ - $(18,182.04)

26065 Blue Cross and Blue Shield of South Carolina SC $22,076,003.24 $6,653,943.39 $(254,611.31)

49532 BlueChoice HealthPlan of South Carolina, Inc. SC $4,157,250.97 $1,402,397.69 $(182,715.35)

60067 Celtic Insurance Company SC $0.00 $(15,590.17) $ -

54362 Cigna Health and Life Insurance Company SC $420,313.62 $447,060.31 $ -


65122 Consumers' Choice Health Insurance Company SC $33,097,630.23 $(6,160,779.32) $(96,974.11)

56262 Coventry Health & Life Insurance Company SC Not Eligible $ - $(12,348.91)

41614 Coventry Health Care of the Carolinas, Inc. SC $18,857,060.88 $(3,828,066.52) $(68,109.07)

33609 Federated Mutual Insurance Company SC Not Eligible $ - $(166,720.12)

80431 Freedom Life Insurance SC $0.00 $(599.88) $ -

17808 Humana Insurance Company SC $2,929.74 $24,910.64 $(3,229.79)

89728 John Alden Life Insurance Company SC Not Eligible $ - $92,798.49

14820 Nippon Life Insurance Company of America SC Not Eligible $ - $(24,753.92)

73714 Standard Security Life SC Not Eligible $ - $(4,600.69)

39996 Time Insurance Company SC $3,954,338.85 $2,251,531.60 $(68,214.40)

64146 UnitedHealthcare Ins Co of River Valley SC Not Eligible $ - $448,146.55

57860 UnitedHealthcare Insurance Company SC Not Eligible $ - $359,514.77

39481 UnitedHealthcare Life Insurance Company SC $1,693,040.39 $(774,807.83) $ -

60536 Avera Health Plans, Inc. SD $10,895,393.31 $(1,014,430.34) $(359,596.30)

66837 Coventry Health and Life Insurance Co. SD $258,935.60 $ (331,736.57) $29,000.90

64255 Federated Mutual Insurance Company SD Not Eligible $ - $(87,499.03)

96594 Medica Insurance Company SD Not Eligible $ - $(23,780.09)

31195 Sanford Health Plan SD $2,844,814.58 $(802,074.46) $26,954.59

62210 South Dakota State Medical Holding Company, Inc. SD $251,215.94 $112,428.12 $(2,099,623.45)

77144 Time Insurance Company SD $365,627.96 $215,435.96 $(4,464.28)

50305 Wellmark of South Dakota SD $11,018,734.68 $1,820,377.38 $2,519,007.76

31552 Aetna Life Insurance Company TN $170,438.32 $(116,538.47) $(866,977.39)

14002 BlueCross BlueShield of Tennessee TN $116,386,840.70 $(1,824,896.38) $6,557,826.76

70111 Celtic Insurance Company TN $0.00 $ (3,104.66) $ -

99248 Cigna Health and Life Insurance Company TN $1,040,048.02 $1,134,427.73 $ -


66842 Community Health Alliance Mutual Insurance Company TN $233,550.84 $259,947.44 $(377,246.42)

78575 Coventry Health and Life TN $28,787.96 $(57,779.81) $(53,103.05)

83463 Federated Mutual Insurance Company TN Not Eligible $ - $(134,889.40)

93222 Humana Health Plan. Inc. TN Not Eligible $ - $(251,013.94)

82120 Humana Insurance Company TN $8,089,911.98 $275,162.36 $(1,959,826.68)

40778 John Alden Life Insurance Company TN Not Eligible $ - $(102,240.68)

17032 Nippon Life Insurance Company of America TN Not Eligible $ - $(26,949.33)

60299 Time Insurance Company TN $3,193,778.58 $191,793.01 $ -

10958 UnitedHealthcare Ins Co of River Valley TN Not Eligible $ - $(3,226,801.76)

69443 UnitedHealthcare Insurance Company TN Not Eligible $ - $441,221.96

48069 UnitedHealthcare Life Insurance Company TN $361,362.20 $140,988.67 $ -

58840 Aetna Health Inc. (a TX corp.) TX Not Eligible $ - $(169,002.71)

91716 Aetna Life Insurance Company TX $14,609,683.22 $7,355,591.68 $(2,896,197.55)

63509 Allegian Insurance Company TX Not Eligible $ - $(10,501.89)

33602 Blue Cross Blue Shield of Texas TX $549,029,026.67 $(17,907,614.72) $16,110,806.25

29418 Celtic Insurance Company TX $0.00 $7,716.90 $ -

55409 Cigna Health and Life Insurance Company TX $82,305,987.68 $32,778,811.09 $ -

46224 Community First Health Plans, Inc. TX $55,520.90 $88,351.39 $ -

27248 Community Health Choice, Inc. TX $642,042.23 $798,055.22 $ -

19046 Federated Mutual Insurance Company TX Not Eligible $ - $(727,599.82)

53799 Freedom Life Insurance TX $763,968.78 $212,352.03 $ -

32673 Humana Health Plan of Texas, Inc. TX $60,111,220.68 $(38,610,710.60) $(1,682,294.43)

63141 Humana Insurance Company TX $21,763,722.99 $5,252,230.85 $(1,055,927.97)

58483 John Alden Life Insurance Company TX Not Eligible $ - $(684,147.34)

82595 Madison National Life TX Not Eligible $ - $(16,438.83)


30609 Memorial Hermann Health Insurance Company, Inc. TX $0.00 $(11,442.15) $(3,622,713.02)

45786 Molina Healthcare of Texas TX $973,697.67 $722,999.82 $ -

45125 Nippon Life Insurance Company of America TX Not Eligible $ - $(24,203.08)

40788 Scott and White Health Plan TX $1,443,594.34 $1,029,126.45 $(1,609,323.38)

71837 Sendero Health Plans, inc. TX $832,608.73 $(1,992,571.72) $ -

26539 SHA, LLC DBA FirstCare Health Plans TX $1,960,486.45 $2,143,995.88 $(367,353.00)

97679 Standard Security Life TX Not Eligible $ - $(207.52)

87226 Superior Health Plan TX $280,267.01 $(933,830.98) $ -

28020 Time Insurance Company TX $22,207,363.63 $8,299,930.29 $262,942.05

98809 UnitedHealthcare Insurance Company TX Not Eligible $ - $(3,289,829.48)

70619 UnitedHealthcare Life Insurance Company TX $2,549,577.18 $767,008.61 $ -

40220 UnitedHealthcare of Texas, Inc. TX Not Eligible $ - $(204,053.17)

81795 USAble Mutual Insurance Company TX Not Eligible $ - $(13,955.11)

38927 Aetna Health of Utah Inc. UT $3,138,343.27 $(1,640,855.99) $347,136.03

27619 Arches Mutual Insurance Company UT $10,242,701.48 $(3,623,028.92) $(521,777.35)

34541 BridgeSpan Health Company UT $1,994,102.22 $(938,474.23) $ -

46958 Humana Insurance Company UT $4,116,155.66 $2,574,546.01 $(1,107,146.32)

56764 Humana Medical Plan of Utah, Inc. UT $3,694,021.94 $(9,861,880.07) $ -

18167 Molina Healthcare of Utah UT $96,992.14 $311,802.19 $ -

22013 Regence BlueCross BlueShield of Utah UT $4,866,764.79 $524,047.97 $1,299,608.61

68781 SelectHealth UT $51,361,644.15 $12,505,596.48 $(1,805,886.51)

44526 Time Insurance Company UT $169,562.38 $105,136.13 $ -

97462 UnitedHealthcare Insurance Company UT Not Eligible $ - $1,548,121.19

43129 UnitedHealthcare Life Insurance Company UT $42,356.49 $43,110.39 $ -

66413 UnitedHealthcare of Utah, Inc. UT Not Eligible $ - $239,944.32


93187 Aetna Health Inc. (a PA corp.) VA Not Eligible $ - $(670,080.10)

38234 Aetna Life Insurance Company VA $7,604,605.22 $7,863,949.40 $(1,438,865.46)

16064 Anthem Health Plans of Virginia, Inc. VA Not Eligible $ - $6,936,085.85

10207 CareFirst BlueChoice, Inc. VA $11,321,522.36 $(6,283,212.33) $(4,403,583.34)

93848 Coventry Health & Life Insurance Co. VA Not Eligible $ - $(933,262.58)

99663 Coventry Health Care of Virginia, Inc VA $11,965,740.50 $2,743,889.18 $(2,031,737.44)

13433 Federated Mutual Insurance Company VA Not Eligible $ - $(385,476.13)

40308 Group Hospitalization and Medical Services Inc. VA $5,469,203.05 $4,207,942.09 $3,282,304.30

88380 HealthKeepers, Inc. VA $53,997,035.62 $(11,644,622.19) $899,569.67

50727 Humana Insurance Company VA $2,612,402.68 $178,764.83 $(11,304.80)

12028 Innovation Health Insurance Company VA $8,970,576.30 $(10,851,778.45) $(656,684.17)

86443 Innovation Health Plan, Inc. VA Not Eligible $ - $(2,752,451.20)

96835 John Alden Life Insurance Company VA Not Eligible $ - $(60,268.14)


States, Inc. VA $6,291,295.43 $(11,219,947.68) $(728,218.07)

89242 Optima Health Insurance Company VA $1,903,358.10 $1,635,203.19 $2,089,955.19

20507 Optima Health Plan VA $14,833,380.88 $19,660,297.48 $1,872,934.03

24251 Optimum Choice, Inc. VA Not Eligible $ - $514,379.01

15668 Piedmont Community HealthCare, Inc. VA Not Eligible $ - $342,665.34

50102 Time Insurance Company VA $4,854,252.39 $3,281,469.92 $186,843.57

66663 United Healthcare Life Insurance Company VA $726,662.22 $428,044.47 $ -

25978 UnitedHealthcare Insurance Company VA Not Eligible $ - $(1,683,466.68)

89498 UnitedHealthcare Plan of the River Valley, Inc. VA Not Eligible $ - $(369,338.77)

34673 Aetna Life Insurance Company WA Not Eligible $ - $(4,980,835.16)

69364 Asuris Northwest Health WA $4,356,897.34 $1,425,226.46 $2,090,209.09


53732 BridgeSpan Health Company WA $3,714,808.43 $6,256,017.45 $ -

18581 Community Health Plan of Washington WA $9,329,339.04 $11,449,602.20 $ -

61836 Coordinated Care Corporation WA $3,216,434.39 $(24,258,945.68) $ -

80473 Group Health Cooperative WA $25,307,015.16 $890,216.02 $(1,709,657.09)

25768 Group Health Options, Inc. WA $9,932,982.42 $(1,364,790.90) $997,685.20

23371 Kaiser Foundation Healthplan of the NW WA $2,684,599.56 $2,144,483.77 $294,987.75

38498 LifeWise Health Plan of WA WA $37,535,881.13 $(32,176,872.96) $ -

65907 Moda Health Plan, Inc. WA $8,479,437.45 $3,727,521.87 $ -

84481 Molina Healthcare of Washington, Inc. WA $1,345,029.79 $3,774,960.62 $ -

49831 Premera Blue Cross WA $58,409,390.63 $(7,124,602.23) $(7,510,310.41)

71281 Regence BlueCross BlueShield Of Oregon WA $3,168,816.20 $1,956,765.45 $(175,111.08)

87718 Regence BlueShield WA $58,586,000.12 $32,511,257.78 $15,701,650.08

42277 Time Insurance Company WA $4,376,501.63 $789,160.16 $ -

94388 Trustmark Life Insurance Company WA Not Eligible $ - $(25,877.34)

18699 UnitedHealthcare Insurance Company WA Not Eligible $ - $(4,690,024.61)

43861 UnitedHealthcare of Washington, Inc. WA Not Eligible $ - $7,283.57

38752 Aetna Life Insurance Company WI Not Eligible $ - $(226,568.25)

39924 All Savers Insurance Company WI Not Eligible $ - $(57,996.40)

90028 BCBS of Wisconsin(Anthem BCBS) WI Not Eligible $ - $(33,656.01)

44197 Celtic Insurance Company WI $0.00 $(4,592.60) $ -

87416 Common Ground Healthcare Cooperative WI $37,246,349.07 $(21,936,044.54) $(1,311,259.94)

79475 Compcare Health Serv Ins Co(Anthem BCBS) WI $21,561,323.02 $(5,890,042.47) $(663,368.87)

38345 Dean Health Plan WI $21,307,603.54 $ (5,448,131.61) $174,003.00

92708 Federated Mutual Insurance Company WI Not Eligible $ - $59,805.56

94529 Group Health Cooperative- SCW WI $296,955.37 $1,297,858.57 $(300,007.81)


91058 Gundersen Health Plan, Inc. WI $5,727,641.40 $417,451.12 $(2,319,871.19)

47342 Health Tradition Health Plan WI $4,487,321.80 $(626,288.42) $(69,764.62)

20173 HealthPartners Insurance Company WI Not Eligible $ - $31,748.61

91604 Humana Insurance Company WI $3,999,657.23 $3,660,246.43 $2,267,328.07

55103 Humana Wisconsin Health Org. Ins. Copr WI Not Eligible $ - $540,251.68

94720 John Alden Life Insurance Company WI Not Eligible $ - $(41,526.94)

57845 Medica Health Plans of Wisconsin WI $2,862,374.50 $(2,323,453.55) $ -

57637 Medica Insurance Company WI Not Eligible $ - $(890,267.24)

64772 Medical Associates Health Plans WI Not Eligible $ - $(494,521.63)

58326 MercyCare HMO, Inc. WI $1,158,384.25 $553,470.57 $176,359.16

35334 MercyCare Insurance Company WI Not Eligible $ - $(394,787.04)

52697 Molina Healthcare of Wisconsin, Inc. WI $3,441,997.05 $4,461,487.73 $ -

81413 Network Health Plan WI $0.00 $17,211.06 $(5,824.29)

58564 Physicians Plus Insurance Corporation WI $140,156.72 $556,347.70 $(104,807.25)

38166 Security Health Plan of Wisconsin, Inc. WI $43,113,883.54 $(4,769,092.74) $(545,101.95)

94073 Time Insurance Company WI $9,155,177.35 $5,745,648.38 $(145,802.24)

59158 UnitedHealthcare Insurance Company WI Not Eligible $ - $2,979,572.04

89106 UnitedHealthcare Life Insurance Company WI $1,343,804.49 $1,384,844.33 $ -

80180 UnitedHealthcare of Wisconsin, Inc. WI Not Eligible $ - $260,942.05

37833 Unity Health Plans Insurance Corporation WI $4,934,795.29 $7,490,116.39 $802,161.46

22554 US Health and Life Insurance Company WI Not Eligible $ - $(5,690.86)

81974 Wisconsin Physicians Svc Insurance Corp WI $29,569,505.70 $9,253,503.82 $391,472.58

84670 WPS Health Plan, Inc. WI $20,641,930.66 $6,159,459.81 $(72,821.47)

26661 Coventry Health & Life Insurance Co. WV Not Eligible $ - $805,014.72

33577 Coventry Health Care of West Virginia, Inc. WV $28,106.85 $(107,392.55) $140,229.75


Table 7: Issuer-Specific Information for Vermont Issuers

HIOS ID

HIOS INPUTTED INSURANCE

COMPANY NAME STATE

REINSURANCE PAYMENT

AMOUNT (OR NOT ELIGIBLE)

HHS RISK ADJUSTMENT

TRANSFER AMOUNT MERGED MARKET (INDIVIDUAL AND

SMALL GROUP MARKETS)

HHS RISK ADJUSTMENT

TRANSFER AMOUNT NON-

MERGED CATASTROPHIC

MARKET

13627 Blue Cross Blue Shield of Vermont VT $25,139,520.11 $2,691,751.51 $(21,502.24)

77566 MVP Health Plan, Inc. VT $2,249,312.88 $(2,691,751.52) $21,502.24

14414 Federated Mutual Insurance Company WV Not Eligible $ - $(9,423.93)

31274 Highmark Blue Cross Blue Shield West Virginia WV $26,810,291.22 $128,655.69 $(413,253.52)

48421 John Alden Life Insurance Company WV Not Eligible $ - $20,283.29

95628 Optimum Choice, Inc. WV Not Eligible $ - $(51,774.44)

72982 The Health Plan of the Upper Ohio Valley WV $61,624.21 $36,581.60 $(127,889.82)

59772 THP Insurance Company WV Not Eligible $ - $16,747.80

35992 Time Insurance Company WV $48,505.44 $(57,844.83) $(59,979.36)

77060 UnitedHealthcare Insurance Company WV Not Eligible $ - $(319,954.48)

79022 Aetna Health of Utah Inc. WY $0.00 $(50,038.73) $11,533.35

11269 Blue Cross Blue Shield of Wyoming WY $7,922,982.99 $6,093,726.20 $(490,054.01)

49290 Celtic Insurance Company WY $0.00 $(16,001.90) $ -

47823 Freedom Life Insurance WY $0.00 $(913.16) $ -

72208 John Alden Life Insurance Company WY Not Eligible $ - $45,022.01

29941 Time Insurance Company WY $5,301,137.18 $36,704.98 $594,176.69

49714 UnitedHealthcare Insurance Company WY Not Eligible $ - $(160,678.00)

53189 WINhealth Partners WY $13,632,956.00 $(6,063,477.37) $ -


VII. HHS Risk Adjustment Default Charge Pursuant to 45 CFR 153.740(b), HHS will assess a default risk adjustment charge if an issuer of a risk adjustment covered plan fails to establish a dedicated distributed data environment (EDGE server) or fails to provide HHS with access to sufficient data such that HHS cannot apply the applicable federally certified risk adjustment methodology to calculate the risk adjustment payment transfer amount for the risk adjustment covered plan in a timely fashion.

The total risk adjustment default charge for a risk adjustment covered plan equals a per member per month (PMPM) amount multiplied by the plan’s enrollment – either provided by the issuer or sought from other reliable sources. The PMPM charge for a plan is equal to the product of the statewide average premium (expressed as a PMPM amount) for a risk pool and the 75th percentile plan risk transfer amount expressed as a percentage of the respective statewide average PMPM premiums for the risk pool. The nationwide percentile reflects only plans in states where HHS is operating the risk adjustment program and is calculated based on the absolute value of plan risk transfer amounts. The determined PMPM amount is then multiplied by a noncompliant plan’s enrollment, to establish the plan’s total default risk adjustment charge.

All compliant risk adjustment covered plans in the risk pool, in the market, in the state of at least one noncompliant issuer will receive a portion of the default charges collected from the noncompliant issuer(s). We allocate default charges collected from noncompliant plans in the risk pool/market/state among the compliant plans in the risk pool/market/state proportional to each compliant plan’s relative revenue requirement as calculated under the transfer formula relative to the market average of these products.

Table 8: HHS Risk Adjustment Default Charge Summary Data

SUMMARY DATA ELEMENT TOTALS

Number of Issuers with Default Charge 10

Percent of Issuers that Received Default Charge 1.30 percent

Table 9: Default Risk Adjustment Charge12

STATE HIOS ID

INSURANCE COMPANY NAME RECEIVING RISK

ADJUSTMENT DEFAULT CHARGE

DEFAULT RISK ADJUSTMENT

CHARGE AMOUNT

AZ 70904 WMI Mutual Insurance Company $(502.38)

12 One Company, SeeChange is being assessed a default charge in the California and Colorado markets; however amounts are not noted here due to insolvency.


AZ 97667 Cigna HealthCare of Arizona, Inc. $(35,103.55) CA 64210 Sutter Health Plan $(637,766.94) CA 79325 GEMCare Health Plan, Inc. $(176,867.65) MD 72564 Evergreen Health Cooperative, Inc. $(2,391,588.16) MT 45632 WMI Mutual Insurance Company $(23,758.28) NV 42313 WMI Mutual Insurance Company $(1,343.86) UT 80043 WMI Mutual Insurance Company $(65,802.25)

Table 10: Default Risk Adjustment Charge by Risk Pool

RISK POOL NATIONAL PERCENT OF PREMIUM

Individual – Non Catastrophic 31 percent Catastrophic 32 percent

Small 19 percent Merged – Non Catastrophic 28 percent

Table 11: Default Charge Allocation13

STATE HIOS ID

INSURANCE COMPANY NAME RECEIVING PAYMENT FROM RISK

ADJUSTMENT CHARGE

DEFAULT RISK ADJUSTMENT ALLOCATION

AMOUNT

AZ 78611 Aetna Health Inc. (a PA corp.) $206.36

AZ 84251 Aetna Life Insurance Company $7,357.58

AZ 98971 All Savers Insurance Company $1.00

AZ 53901 Blue Cross Blue Shield of Arizona, Inc. $6,337.25

AZ 86830 Cigna Health and Life Insurance Company $4.80

AZ 51485 Health Net Life Insurance Company $11,053.07

AZ 91450 Health Net of Arizona, Inc. $2,449.19 AZ 23307 Humana Health Plan, Inc. $2,256.88 AZ 66105 Humana Insurance Company $1,163.28

AZ 73893 John Alden Life Insurance Company $417.74

AZ 23029 Madison National Life $0.37

13 Due to insolvency, SeeChange default charge amounts in the California and Colorado markets are not reflected in the allocation amounts on this table for issuers operating in those respective markets.


AZ 60761 Meritus Health Partners $16.97

AZ 92045 Meritus Mutual Health Partners $67.76

AZ 59096 Standard Security Life $0.03 AZ 80863 Time Insurance Company $467.69

AZ 82011 UnitedHealthcare Insurance Company $3,768.34

AZ 40702 UnitedHealthcare of Arizona, Inc. $37.56

CA 20523 Aetna Health of California Inc. $38,476.84

CA 40733 Aetna Life Insurance Company $20,609.25

CA 27603 Blue Cross of California(Anthem BC) $166,136.75

CA 70285 CA Physician's Service dba Blue Shield of CA $166,485.35

CA 47579 Chinese Community Health Plan $3,624.19

CA 40025 Cigna Health and Life Insurance Company $1,166.68

CA 99483 CONTRA COSTA HEALTH PLAN $146.71

CA 84014 County of Santa Clara $154.22

CA 56887 County of Ventura, dba Ventura County Health Care Plan $625.12

CA 99110 Health Net Life Insurance Company $57,969.17

CA 67138 Health Net of California, Inc $28,864.18 CA 68744 Humana Insurance Company $20.04

CA 40513 Kaiser Foundation Health Plan, Inc. $271,878.96

CA 27330 Kaiser Permanente Insurance Company $238.32

CA 92815 Local Initiative Health Authority for Los Angeles County $825.78


CA 18126 MOLINA HEALTHCARE OF CALIFORNIA $301.72

CA 92499 Sharp Health Plan $6,057.42 CA 64198 Time Insurance Company $2,563.43

CA 35305 Trustmark Life Insurance Company $66.08

CA 49116 UHC of California $15,655.96

CA 95677 UnitedHealthcare Insurance Company $17,427.60

CA 93689 Western Health Advantage $15,340.70 MD 66516 Aetna Health Inc. (a PA corp.) $24,195.68

MD 70767 Aetna Life Insurance Company $74,511.37

MD 28137 CareFirst BlueChoice, Inc. $1,327,713.52 MD 45532 CareFirst of Maryland, Inc. $66,285.85 MD 68541 Coventry Health and Life $106,039.55

MD 14468 Coventry Health Care of Delaware, Inc. $105,015.44

MD 94084 GHMSI $244,147.61

MD 90296 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. $105,074.81

MD 65635 MAMSI Life and Health Insurance Company $93,441.35

MD 72375 Optimum Choice, Inc. $77,878.91

MD 23620 UnitedHealthcare Insurance Company $128,315.11

MD 31112 UnitedHealthcare of the Mid-Atlantic Inc $38,968.77

MT 30751 Blue Cross and Blue Shield of Montana $18,026.04

MT 63342 Independence American Ins Co $3.04

MT 64206 John Alden Life Insurance Company $447.92

MT 49669 Madison National Life $4.53 MT 32225 Montana Health Cooperative $996.01 MT 23603 PacificSource Health Plans $4,073.14 MT 24867 Time Insurance Company $197.49


MT 46621 UnitedHealthcare Insurance Company $10.15

NV 19298 Aetna Health Inc. (a PA corp.) $10.30

NV 27990 Aetna Life Insurance Company $149.56

NV 65779 Altius Health Plans Inc. $0.54

NV 49021 Coventry Health & Life Insurance Company $9.49

NV 95865 Health Plan of Nevada, Inc. $336.13

NV 60156 HMO Colorado Inc dba HMO NV(Anthem BCBS) $2.52

NV 41094 HOMETOWN HEALTH PLAN, INC $3.85

NV 85266 HOMETOWN HEALTH PROVIDERS INS. CO. INC. $10.27

NV 93696 Humana Health Plan Inc. $9.28 NV 20895 Humana Insurance Company $70.33

NV 87446 John Alden Life Insurance Company $11.50

NV 34996 Nevada Health CO-OP $16.69 NV 16698 Prominence HealthFirst $31.50

NV 68524 Prominence Preferred Health Insurance Company, Inc. $43.85

NV 33670 Rocky Mountain Hos&Med Svc(Anthem BCBS) $166.30

NV 83198 Sierra Health and Life Ins Company, Inc. $354.97

NV 29211 Time Insurance Company $17.68

NV 74222 UnitedHealthcare Insurance Company $99.08

UT 38927 Altius Health Plans Inc. $1,878.12

UT 27619 Arches Mutual Insurance Company $648.41

UT 46958 Humana Insurance Company $928.00

UT 22013 Regence BlueCross BlueShield of Utah $11,648.37

UT 68781 SelectHealth $48,797.36

UT 97462 UnitedHealthcare Insurance Company $1,763.36


UT 66413 UnitedHealthcare of Utah, Inc. $138.56


Appendix A: Description of Table 5 Calculated Columns

State Average Premium

The state market risk pool plan average premium is part of the risk adjustment transfer formula and is the sum of all plan enrollments multiplied by the plan’s average premium for the risk pool market in a state. The state average premium is weighted by plan share of statewide enrollment in the risk pool.

State Average Plan Liability Risk Score (PLRS)

The state average PLRS is calculated as the summed products of PLRS and billable member months for all plans within the state market risk pool divided by total billable months for all plans within the state market risk pool.

State Average Allowable Rating Factor (ARF) for Affordable Care Act Rated States

The state average ARF is calculated as the summed products of ARF and billable member months for the plans within the state market risk pool divided by total billable member months for all plans in the state market risk pool.

State Average Actuarial Value (AV)

The state average AV is calculated as the summed products of AV and billable member months for the plans within the market risk pool divided by the total billable member months within the state market risk pool. AV corresponds with metal and catastrophic tiers as follows:

*Catastrophic: 0.57 *Bronze: 0.60 *Silver: 0.70 *Gold: 0.80 *Platinum: 0.90

Documents

SUMMARY REPORT ON TRANSITIONAL REINSURANCE … · 6/30/2015 · PAYMENTS AND PERMANENT RISK ADJUSTMENT TRANSFERS . FOR THE 2014 BENEFIT YEAR . Issued: June 30, 2015 . RI-RA Payments